Don't Add Excision Lengths for Lesions
Question: Would you please explain adding excision sizes together? If the physician excises a lesion (malignant or not), should I add the sizes together?
Maryland Subscriber
Answer: You should never add lesion excisions together.
You should code excisions (11400-11646) according to the specific site, times the number of excisions the physician performed. For example, you would report 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) with a quantity of "four" service units on the claim if the physician removed four lesions.
You may be thinking of repairs, in which case you should add the total of the lengths of the wounds or lacerations repaired together in each type of repair category - simple, intermediate and complex (12001-13160) - according to the body area and location of the wounds or lacerations.
Question: When a physician performs a colonoscopy in an outpatient setting, I know that the conscious sedation is bundled into the "professional component." But can the facility bill for conscious sedation, based on the nurse's observation time and drugs administered?
Arkansas Subscriber
Answer: Technically, the hospital's fee for conscious sedation is bundled into the ambulatory payment classification (APC) payment for the procedure, so Medicare won't give you separate payment for it. But that doesn't mean you shouldn't report it on a separate line.
Code 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) has a status indicator of "N," which means that the payment for the service is included in the APC. But CMS still wants you to report the service separately, because having that data affects how they determine codes and reimbursement in the future.
Question: Can we report revenue code 260 without an accompanying HCPCS code? This code is listed in CMS' Internet-only manual as "packaged," and thus not requiring a HCPCS code.
Delaware Subscriber
Answer: According to the Ingenix UB-92 Editor guide, HCPCS codes are required in form locator 44 on the UB-92 for intravenous (IV) therapy services billed by acute care, long-term care, rehabilitation and psychiatric hospitals, and hospital-based Rural Health Clinics. Check with your payer about its rules for your type of facility.
- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
