Accuracy is essential in medical billing. As modifiers and codes change, it’s important for hospitals to make the most of your medical billing experience and stay updated to increase the potential for maximum patient claim profits.

Hospitalist Code Ranges for 2023

The following are updated CPT codes for hospitalists in 2023:

• 99221 – hospital inpatient care services (new or established patient)
• 99222 – hospital inpatient care services (new or established patient)
• 99223 – hospital inpatient care services (new or established patient)
• 99231 – subsequent hospital care services
• 99232 – subsequent hospital care services
• 99233 – subsequent hospital care services
• 99238 – hospital discharge services
• 99239 – hospital discharge services
• 99252 – outpatient consultation services (new or established patient)
• 99253 – outpatient consultation services (new or established patient)
• 99254 – outpatient consultation services (new or established patient)
• 99255 – outpatient consultation services (new or established patient)
• 99291 – critical care services
• 99292 – critical care services
• 99242 – inpatient consultation services (new or established patient)
• 99243 – inpatient consultation services (new or established patient)
• 99244 – inpatient consultation services (new or established patient)
• 99245 – inpatient consultation services (new or established patient)

Hospitalist Modifiers

Use modifiers to make codes more accurate and specific in order to increase collections from claims.

• 25 – indicates a visit is separate from a procedure performed on the same day
• 310 – not vaccinated against COVID-19
• 311 – partly vaccinated against COVID-19
• 39 – indicates any other under-immunized status

Learn more in our Hospitalist medical billing services.

CPT codes, or Current Procedural Terminology codes, allow doctors and medical professionals to report medical services and procedures uniformly, easily, and accurately. Modifiers can be added to CPT codes to describe a procedure further or add extra details. Your dermatology practice can benefit from knowing the most updated CPT codes, as shown below for 2023.

Changes to Codes 2023

The updated CPT codes for 2023, released by the American Medical Association (AMA) at the end of 2022, made a few changes to the current codes. These include establishing one set of evaluation and management services (E/M) guidelines, which should help make coding more streamlined throughout inpatient and outpatient practices. Additionally:

• Level one consultation codes 99241 and 99251 have been deleted
• The code 99281 may not require the presence of a physician or other qualified healthcare professional

Common Dermatology CPT Codes 2023

The following are the newest CPT codes for common dermatology procedures.

Evaluation and Management

Consultations

The following are newly updated codes and ranges for consultation codes, according to the 2023 AMA guidelines.

• 99242: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making
• 99243: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision-making
• 99244: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision-making
• 99245: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision-making

Visits and Evaluations

• 99201: Problem-focused office visit from new patient
• 99202: Expanded problem-focused office visit from new patient
• 99203: Detailed office visit from new patient
• 99204: Comprehensive office visit from new patient with review of 2-9 symptoms
• 99205: Comprehensive office visit from new patient with review of 10 or more symptoms
• 99211: Straightforward office visit from established patient
• 99212: Problem-focused office visit from established patient
• 99213: Expanded problem-focused office visit from established patient
• 99214: Detailed office visit from established patient
• 99215: Comprehensive office visit from established patient

Biopsies

• 11100: Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion
• 11101: Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each additional lesion
• 11102: Tangential biopsy of skin; single lesion
• 11103: Tangential biopsy of skin; each separate/additional lesion
• 11104: Punch biopsy of skin; single lesion
• 11105: Punch biopsy of skin; each separate/additioal lesion
• 11106: Incisional biopsy of skin; single lesion
• 11107: Incisional biopsy of skin; each separate/additional lesion

Destruction of Lesions

• 17000: Destruction of premalignant lesions; first lesion
• 17003: Destruction of premalignant lesions; 2-14 lesions
• 17110: Destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

Mohs Surgery

• 17311: Mohs micrographic technique on head, neck, hands, feet; first stage
• 17312: Mohs micrographic technique on head, neck, hands, feet; each additional stage
• 17313: Mohs micrographic technique on trunk, arms, and legs; first stage
• 17314: Mohs micrographic technique on trunk, arms, and legs; each additional stage

Excisions

• 11403: Excision, benign lesion including margins; trunk, arms, or legs
• 11603: Excision, malignant lesion including margins; trunk, arms or legs

Phototherapy

• 96900: Actinotherapy (ultraviolet light)
• 96910: Photochemotherapy; tar and ultraviolet B or petrolatum and ultraviolet B
• 96567: Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions
• J7308: Aminovulinic acid HCL for topical administration

Laser Treatment

• 96920: Laser treatment for inflammatory skin disease
• 96921: Laser treatment for inflammatory skin disease

Modifiers

Modifiers help modify CPT codes to add more detail or distinguish between repeat codes.

• 25: Separate evaluation on the same day as another procedure or service
• 59: Repetition of procedure on a different extremity
• 91: Repeat tests taken on the same day with different specimens at different times
• 95: synchronous telemedicine service rendered via real-time Interactive audio and video telecommunications system
• 310: Not vaccinated against COVID-19
• 311: Partly vaccinated against COVID-19
• 39: Indicates any other under-immunized status

Learn more in our Dermatology medical billing services.

What is Modifier 24

Modifier 24 is a billing code used by healthcare providers to indicate that an unrelated evaluation and management (E&M) service was performed by the same physician, nurse practitioner, or physician assistant during a postoperative period. The use of this modifier is intended to help providers receive proper reimbursement for services that may not be covered by the primary procedure.

For example, a physician may perform a surgical procedure on a patient and then provide follow-up care during the postoperative period. If the physician also performs an E&M service, such as an office visit, during that time, they can use modifier 24 to indicate that the E&M service was not related to the surgical procedure and should be billed separately.

Coding and Use of Modifier 24

Modifier 24 is typically used in conjunction with CPT® codes for E&M services, such as office visits, and can be applied to a variety of specialties. Knowing when to assign modifiers is half the battle. Here are a few examples of how different specialties may use modifier 24 with certain CPT codes:

• Orthopedic Surgery: A patient may have surgery on their knee, and then visit the orthopedic surgeon for a follow-up visit during the postoperative period. In this case, the orthopedic surgeon would use modifier 24 in conjunction with the CPT code for the evaluation and management service.
• Cardiology: A patient may have a cardiac catheterization procedure, and then visit the cardiologist for a follow-up visit during the postoperative care period. In this case, the cardiologist would use assign modifier 24 in conjunction with the EM service CPT code for the office visit.
• Obstetrics and Gynecology: A patient may have a cesarean section, and then visit the obstetrician-gynecologist for a follow-up visit during the postoperative period. In this case, the obstetrician-gynecologist would use modifier 24 in conjunction with the CPT code for the office visit.
• Gastroenterology: A patient may have an endoscopy procedure, and then visit the gastroenterologist for a follow-up visit during the postoperative period. In this case, the gastroenterologist would use modifier 24 in conjunction with the CPT code for the office visit.

It is important to note that the use of modifier 24 is subject to the rules and regulations set by the American Medical Association (“AMA”), the Centers for Medicare and Medicaid Services (CMS) and private payers. Providers should check with the appropriate payer to ensure they are using the modifier correctly and to avoid denied claims.

Modifier 24 and 25 – When Should I use 24 v 25?

Modifiers 24 and 25 are codes used by healthcare providers to indicate that additional services were performed during a patient visit. While both modifiers are used to indicate that an unrelated evaluation and management (E&M) service was performed, they are used in different situations.

Modifier 24 is used to indicate that an unrelated E&M service was performed by the same physician, nurse practitioner, or physician assistant during a postoperative period. This modifier is used to receive proper reimbursement for services that may not be covered by the primary procedure. For example, a physician may perform a surgical procedure on a patient and then provide follow-up care during the postoperative period. If the physician also performs an E&M service, such as an office visit, during that time, they can use modifier 24 to indicate that the E&M service was not related to the surgical procedure and should be billed separately.

Modifier 25, on the other hand, is used to indicate that a significant, separately identifiable E&M service was performed on the same day as a procedure or other service. This modifier is used to indicate that the E&M service was not included in the primary procedure and should be billed separately. For example, a patient may have a diagnostic test, such as a CT scan, and then visit the physician for an E&M service, such as an office visit, on the same day. In this case, the physician would use modifier 25 to indicate that the E&M service was not included in the diagnostic test and should be billed separately.

It’s important to note that the use of modifier 24 and 25 is subject to the rules and regulations set by the Centers for Medicare and Medicaid Services (CMS) and private payers. Providers should check with the appropriate payer to ensure they are using the modifiers correctly and to avoid denied claims.

Here are a few examples of when you would use modifier 24 and 25:

• Modifier 24: A patient has surgery on their knee and then visits the orthopedic surgeon for a follow-up visit during the postoperative period. In this case, the orthopedic surgeon would use modifier 24 in conjunction with the CPT code for the office visit.
• Modifier 25: A patient has a diagnostic test, such as a CT scan, and then visits the radiologist for an interpretation of the test on the same day. In this case, the radiologist would use modifier 25 in conjunction with the CPT code for the interpretation service.
• Modifier 24: A patient has a cardiac catheterization procedure, and then visits the cardiologist for a follow-up visit during the postoperative period. In this case, the cardiologist would use modifier 24 in conjunction with the CPT code for the office visit.
• Modifier 25: A patient has a diagnostic test, such as an MRI, and then visits the radiologist for an interpretation of the test on the same day. In this case, the radiologist would use modifier 25 in conjunction with the CPT code for the interpretation service.

If a patient sees a physician during a postoperative period, it’s important to document the reason for the E&M service and the fact that it was performed during the post-op period. This documentation should be included in the patient’s medical record to support the use of modifier 24. The use of modifier 24 is subject to review by coder and payers, and it is important to ensure the E&M service is medically necessary with a proper icd-10 code (diagnosis code) and that it is not included in the global period.

Part B Medicare and Modifiers 24 and 25:

The use of modifier 24 and 25 are subject to the rules and regulations set by the Centers for Medicare and Medicaid Services (CMS) and private payers. For example, in the case of Medicare Part B, the use of modifier 24 is subject to the regulations set by CMS. It is important for a medical coder or certified professional coder (“CPC”) to check with the appropriate payer to ensure the modifier is used correctly.

In conclusion, modifier 24 is a valuable tool for physicians, nurse practitioners, and physician assistants to receive proper reimbursement for unrelated E&M services performed during a postoperative period. The modifier can be used in a variety of specialties and in conjunction with CPT codes for E&M services. However, it is important to follow the rules and regulations set by CMS and private payers and to document the reason for the E&M service and the fact that it was performed during a postoperative period.