Since 2021, E/M (Evaluation and Management) coding no longer relies on "bean counting" history and exam elements. Today, the code level is determined by either Total Time spent on the visit day or the Medical Decision Making (MDM). For most dermatology visits, MDM is king.

MDM or Time: Choosing Your Method

Medical Decision Making (MDM):

• This is the most common method. It's based on 3 elements:
• 1. Number & Complexity of Problems Addressed
• 2. Amount & Complexity of Data to be Reviewed
• 3. Risk of Complications / Morbidity from treatment.

Total Time:

• Includes *all* provider time on the date of service (face-to-face, charting, ordering tests, reviewing records).
• Great for long counseling visits (e.g., complex psoriasis management or isotretinoin counseling).

New vs. Established: New patients (99202-99205) are those not seen by you or a partner in 3 years. Established patients (99212-99215) have been.

The Modifier 25 Challenge

• If you perform a procedure (like a biopsy or cryo) on the same day as an E/M visit, you must append Modifier 25 to the E/M code.
• This signifies a "significant, separately identifiable" E/M service.
• You cannot bill an E/M visit just for the decision to do a procedure (that's bundled).
• Example: Patient comes for a rash (E/M visit) and you also freeze a wart (procedure). The rash evaluation is separate, so you can bill 9921x-25 and 17110.
• Example (No-Go): Patient comes in only for a wart. You bill 17110. You cannot also bill a 99212 for evaluating the wart.

The Modifier 25 Audit Risk