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Claim issue being addressed: E&M services billed with skin tag/skin lesion procedures

Horizon Blue Cross Blue Shield of New Jersey is investigating a system issue that is causing claims for service dates November 1, 2014 and after to process contrary to the guidelines outlined in our reimbursement policy, Skin Tags and/or Skin Lesions with E&M.

Presently, our claim system is denying Evaluation and Management (E&M) services billed by the same provider as a skin tag/skin lesion procedure* performed on that same date of service regardless of the diagnoses submitted for each service.

According to our reimbursement policy, E&M services billed by the same provider as skin tag/skin lesion procedure performed on that same date of service will be considered incidental to that skin tag/skin lesion procedure and will not be eligible for separate reimbursement (even if appended with modifier 25) if the diagnoses submitted for the E&M and for the skin tag/skin lesion procedure are the same.

We are currently investigating this issue and will provide information about when impacted claims will be corrected in a future announcement.

Thank you for your patience as we work to resolve this issue.

* Skin tag procedures include CPT® codes 11200 and 11201. Skin lesion procedures include CPT codes 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17250, 17260, 17261, 17262, 17263, 17264, 17266, 17270, 17271, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284 and 17286.

CPT® is a registered trademark of the American Medical Association.

Published on: January 12, 2015, 08:00 a.m. ET
Last updated on: February 3, 2017, 03:02 a.m. ET