Medicare offers coverage for an Evaluation and Management (E/M) service when it’s necessary and practical for diagnosing or treating health conditions or enhancing the function of a deformed body part. Usually, for global surgery operations, Medicare covers the costs of the necessary services rendered before and after surgery by a surgeon. Medicare’s global surgery guidelines lay out how to report E/M services with minor surgery procedures. Generally, the payments for E/M services offered on the day of a minor surgical procedure are included in the procedure’s total payment. The decision to perform a minor procedure is encompassed within the surgery’s payment, and should not be reported as a separate E/M service. If a surgeon provides a significant, separately identifiable E/M service on the same day as performing a minor surgery, it should only be billed on the same day. In this case, the provider should append a modifier 25 to the appropriate E/M code. In 2019, an estimated 56% of claims by dermatologists for an E/M service also contained minor surgeries (like removing lesions, performing destructions, and biopsies) on the same day.

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The Centers for Medicare & Medicaid Services has issued a revision about dermatologist claims for evaluation and management services performed on the same day as minor surgical procedures. This revision is referenced under the report number W-00-21-35868 by the Office of Audit Services. The expected issue date is forecasted for the fiscal year 2024.

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Originating Article: Hss.gov | Dermatologist Claims for Evaluation and Management Services on the Same Day as Minor Surgical Procedures (hhs.gov)