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Update: E&M Services Billed with Skin Tag/Skin Lesion Procedures Claims Issue

On January 12, 2015, we reported a system issue that resulted in certain claims being processed contrary to our reimbursement policy guidelines.

On January 22, 2015, we began adjusting erroneously denied claims for Evaluation and Management (E&M) services billed by the same provider on the same date of service as a skin tag/skin lesion procedure* if the diagnosis codes assigned to the E&M and for the skin tag/skin lesion procedure were different. All impacted claims finalized between November 1, 2014 and January 16, 2015 will be corrected by the end of February 2015.

We thank you for your patience and we apologize for any inconvenience caused by this system issue.

According to our reimbursement policy, Skin Tags and/or Skin Lesions with E&M, 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 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.

*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: February 9, 2015, 08:00 a.m. ET
Last updated on: November 24, 2020, 23:29 p.m. ET