In a particular case, a patient presents for a follow-up of an ingrown toe nail. The podiatrist finds that the patient now has two ingrown toenails – one on each foot. He removes both from each toe and also did a silver nitrate cauterization. How should I report this? Should I report 99212-25?
Well, the answer is yes. Besides coding 99212-25, you should bill 11750 (Excision of nail and nail matrix, partial or complete [example, ingrown or deformed nail], for permanent removal) appended by modifier 50 (Bilateral procedure).
Logic for evaluation & management: Since the diagnosis is new to one toe, you could justify 99212 (Office or other outpatient visit for the E/M of an established patient which requires at least two of these three key components: a problem focused history; a problem focused examination, and straightforward medical decision making; Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The patient presents for follow-up of one ingrown toenail. However, the podiatrist has not examined the other (new) ingrown toenail earlier.
Adding modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) to 99212 indicates the podiatrist carries out a significant, separate service from the ingrown toenail removal.
Logic for incision: You should report each toenail removal: 11750 for the first complete removal and 11750 for the second removal. Using modifier 50 to the second removal tells the insurer that the podiatrist carries out the toe removal as bilateral procedure.
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