CPCA Modifier Use in Dermatology 3 — Questions and Answers
Question 1: In dermatology, modifier 25 is appended to an E/M service code when:
- The E/M is performed on a different date than the procedure
- A significant, separately identifiable E/M is performed on the same day as a minor procedure (Correct answer)
- The patient is seen for a follow-up within the global period
- The E/M involves a new patient
Correct answer: A significant, separately identifiable E/M is performed on the same day as a minor procedure
Modifier 25 signals that a significant, separately identifiable evaluation and management service was provided on the same day as a procedure.
Question 2: A patient presents for destruction of multiple actinic keratoses. Five lesions are treated. How are the additional lesions (beyond the first) coded?
- Each is billed with a separate CPT code and modifier 51
- Additional lesions are included in the base code without separate billing
- Additional lesions are reported with add-on codes (Correct answer)
- Each additional lesion requires modifier 59
Correct answer: Additional lesions are reported with add-on codes
CPT includes add-on codes (e.g., 17003) for each additional actinic keratosis destroyed beyond the first two, which do not require modifier 51.
Question 3: When coding Mohs surgery, modifier 51 is NOT added to additional Mohs stage codes because:
- Mohs stages are billed to different payers
- Add-on codes are exempt from modifier 51 (Correct answer)
- Mohs surgery is never billed with other procedures
- Modifier 51 only applies to E/M codes
Correct answer: Add-on codes are exempt from modifier 51
Add-on codes, including those for additional Mohs stages, are inherently exempt from modifier 51 per CPT guidelines.
Question 4: A patient undergoes excision of a cyst on the neck and a separate excision of a lipoma on the back in the same session. Which modifier is required on the second procedure?
- Modifier 59
- Modifier 51 (Correct answer)
- Modifier 52
- Modifier 22
Correct answer: Modifier 51
Modifier 51 is appended to the second and subsequent procedures when multiple surgical procedures are performed at the same session by the same surgeon.
Question 5: Modifier 22 in dermatology is used to indicate:
- A procedure performed on a newborn
- Increased procedural services beyond what is usually required (Correct answer)
- Bilateral procedures
- A reduced service level
Correct answer: Increased procedural services beyond what is usually required
Modifier 22 is appended when the work required to perform the procedure is substantially greater than typically required, justifying additional reimbursement.
Question 6: Which modifier is used when the same procedure is performed on both the right and left sides of the body in dermatology?
- Modifier 51
- Modifier 50 (Correct answer)
- Modifier 59
- Modifier 52
Correct answer: Modifier 50
Modifier 50 is used to report bilateral procedures performed during the same operative session.
Question 7: A dermatologist sees a patient for follow-up within the 10-day global period of a shave removal and identifies and treats a new, unrelated skin infection. How should the E/M service be billed?
- It cannot be billed separately during the global period
- Bill with modifier 24 to indicate an unrelated E/M during the postoperative period (Correct answer)
- Bill with modifier 25
- Bill with modifier 79
Correct answer: Bill with modifier 24 to indicate an unrelated E/M during the postoperative period
Modifier 24 is used for an unrelated evaluation and management service provided during a postoperative period.
CPCA Modifier Use in Dermatology 3
In dermatology, modifier 25 is appended to an E/M service code when: