CPCA Modifier Use in Dermatology Questions and Answers

Question 1

A new patient presents for a comprehensive full-body skin examination due to a family history of melanoma.
During this extensive evaluation, the dermatologist identifies a highly suspicious 0.8 cm nevus on the patient's back and performs a shave biopsy in the same visit.
How should the services be coded to ensure proper reimbursement for both the distinct evaluation and the minor procedure?

Accepted Answer

Append modifier 25 to the E/M code.

Answer

Bill only for the shave biopsy as the exam is included.

Answer

Append modifier 59 to the E/M code.

Answer

Report the E/M code and the biopsy code with no modifiers.

Question 2

A dermatologist performs cryosurgery on two separate and distinct actinic keratosis lesions during the same office visit: one on the forehead and one on the left hand. Which modifier is most appropriate to append to the CPT code for the second lesion to indicate it was a distinct procedure at a different anatomical site?

Accepted Answer

Modifier 59

Answer

Modifier 51

Answer

Modifier 76

Answer

Modifier 25

Question 3

A patient undergoes a shave removal of a benign lesion from their right middle finger and another from their left index finger. Which set of HCPCS Level II anatomical modifiers should be used to specify the exact location of these two procedures?

Accepted Answer

F7 and F2

Answer

RT and LT

Answer

F3 and F6

Answer

T7 and T2

Question 4

A dermatologist performs a wide excision of a confirmed melanoma on a patient's back. During the same operative session, the physician also performs a punch biopsy of a completely unrelated suspicious lesion on the patient's shoulder. Which of the following modifiers should be appended to the punch biopsy code?

Accepted Answer

Modifier 51

Answer

Modifier 59

Answer

Modifier 25

Answer

Modifier 58

Question 5

A patient had a benign cyst excised from their arm, a procedure with a 10-day global period. Six days later, the same patient returns to the same dermatologist for an entirely new and unrelated issue: an acute allergic rash on their legs that requires evaluation and management. Which modifier should be appended to the E/M service code for the rash visit?

Accepted Answer

Modifier 24

Answer

Modifier 79

Answer

Modifier 58

Answer

Modifier 25

Question 6

A dermatologist performs a punch biopsy of a lesion on a patient's leg. The pathology report confirms malignancy. The patient returns five days later, within the biopsy's 10-day global period, for a planned wide local excision of the cancerous site by the same dermatologist. Which modifier should be appended to the CPT code for the wide local excision?

Accepted Answer

Modifier 58

Answer

Modifier 79

Answer

Modifier 78

Answer

Modifier 59