complex repair

  1. E

    Wiki Aetna not paying Complex Skin Repairs

    We are having an extremely hard time with Aetna paying for a complex repair - we bill 11402 Diagnosis code D22.71, Aetna will pay the 11402 , but reject the 13121 even after office notes are uploaded. We have tweaked our documentation to list the layers included in the closure, can anyone...
  2. J

    Wiki Appropriate modifier for CPT 13122 and 17311

    Good morning everyone! I have a quick question regarding these three CPT codes. Pt came in for a MOHS procedure, as well as a complex repair afterwards. The following CPT codes were used: 13122 17312 17311 Initially, modifier 51 was used on 13122, however it was denied by UHC. Replaced it with...
  3. S

    Wiki Intermediate/complex Repair documentation

    Our complex or intermediate repair notes will say closed with buried #__ polysorb sutures and # ___nylon sutures. Does not directly state layered repair or what layer of tissue they are closing with those sutures. Is this not required information? Or is stating buried sutures enough...
    • SUN1633
    • Thread
    • complex repair documentation improvement intermediate
    • Replies: 1
    • Forum: Dermatology
  4. C

    Wiki Complex repair plus graft on same site

    If a wound requires a complex repair for one piece of it, plus a graft for the remaining little piece that couldn't be closed with the complex repair, can you bill both?
  5. M

    Wiki Mohs, repairs, multiple code combo denials

    I'm new to Derm and I'm coming across a lot of denial issues. Examples below. Feedback appreciated! 13132-59 Claim paid 11200 Charge denied Shouldn't both claims pay seeing that the 59 was added for the NCCI edit? 17311-79 17311-79-59 (BSC left mid-jawline and BSC left lateral...
  6. M

    Wiki 14301 denied as not med necessary

    Patient defect after Mohs was determined by surgeon to require advancement flap 14301. Aetna requested notes on the case 2 times. Notes and photos were sent to support med nec. of 14301. Aetna denied the 14301 as not medically necessary. OrthoNet advised we should have billed complex repair...
    • MichaelGA
    • Thread
    • adjacent tissue transfer advancement flap complex repair
    • Replies: 2
    • Forum: Dermatology
  7. M

    Wiki Complex repair 13132 rejected after billed with 17000 destruction

    I'm new to Derm. Patient had Mohs layer 17311 and the following on the same DOS. Patient had complex repair 13132, and the physician also destroyed a lesion- 17000. The Mohs and destruction paid; however, the complex repair was denied- (PTP edits for 13132 to the 17000). Is this a simple fix...
    • MichaelGA
    • Thread
    • complex repair mohs ncci edits ptp edits
    • Replies: 2
    • Forum: Dermatology
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