Author Topic: Can I bill a surgical excision and closure without the office visit?  (Read 2104 times)

Michele

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Question
Dear Biller,
I'm a dermatologist in NYC and I'd like to run a two-part undercoding question past you:
Can you bill for an office/outpatient surgical excision (11401) and complex closure (11301) without billing for the office visit (99202); and if so, will the commercial carrier reimbursement be higher for the above two surgical procedures (when excluding the office visit)?

Thanks,
GC

Answer
Hi Gil,
Thanks for the question. Yes, you can bill for just the 2 surgical procedures without billing for an office visit. There is no rule that you MUST bill for the office visit, even if it is the first time you're seeing the patient. In answer to your second part of the question, not billing the office visit should not increase the reimbursement for the 2 surgical codes. Each insurance carrier allows a certain fee for each CPT code. Office Visits do not change the fee. I would think you would be reimbursed more if you did bill the office visit code with a 25 modifier. This way they would allow the fee schedule for the office visit and for the 2 surgical procedures.
I hope that helps you out!
Thanks
Michele

Thanks for your quick and helpful response. Your reply confirmed my general thinking on this subject, and I appreciate your succinct and clear explanation.
With much appreciation,
Gil
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