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Slraheb

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Hi,
I was wondering if any of you when billing a 21552 and a 13132 together if they denied the repair code of 13132 as being bundled and what is the best way to appeal these to show they can be billed separately. Any help would be appreciated.
 
If the 13132 is for the closure of the surgical wound, then it is correct that it is bundled. Complex closure may be billed in addition to excisions of skin/subcutaneous lesions but the deep tissue excisions such as 21552 already include closure. The only way you can successfully appeal this denial is if the 13132 was unrelated to the surgical procedure billed with 21552.

Per the NCCI manual:

Closure/repair of a surgical incision is included in the global surgical package except as noted below. Wound repair CPT codes 12001-13153 shall not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090, or MMM. Simple, intermediate, and complex wound repair codes may be reported with Mohs surgery (CPT codes 17311-17315). Intermediate and complex repair codes may be reported with excision of benign lesions (CPT codes 11401-11406, 11421-11426, 11441-11471) and excision of malignant lesions (CPT codes 11600-11646). Wound repair codes (CPT codes 12001-13153) shall not be reported with excisions of benign lesions with an excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440).
 
thomas7331 said:
If the 13132 is for the closure of the surgical wound, then it is correct that it is bundled. Complex closure may be billed in addition to excisions of skin/subcutaneous lesions but the deep tissue excisions such as 21552 already include closure. The only way you can successfully appeal this denial is if the 13132 was unrelated to the surgical procedure billed with 21552.

Per the NCCI manual:

Closure/repair of a surgical incision is included in the global surgical package except as noted below. Wound repair CPT codes 12001-13153 shall not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090, or MMM. Simple, intermediate, and complex wound repair codes may be reported with Mohs surgery (CPT codes 17311-17315). Intermediate and complex repair codes may be reported with excision of benign lesions (CPT codes 11401-11406, 11421-11426, 11441-11471) and excision of malignant lesions (CPT codes 11600-11646). Wound repair codes (CPT codes 12001-13153) shall not be reported with excisions of benign lesions with an excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440).
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thank you
 
thomas7331 said:
If the 13132 is for the closure of the surgical wound, then it is correct that it is bundled. Complex closure may be billed in addition to excisions of skin/subcutaneous lesions but the deep tissue excisions such as 21552 already include closure. The only way you can successfully appeal this denial is if the 13132 was unrelated to the surgical procedure billed with 21552.

Per the NCCI manual:

Closure/repair of a surgical incision is included in the global surgical package except as noted below. Wound repair CPT codes 12001-13153 shall not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090, or MMM. Simple, intermediate, and complex wound repair codes may be reported with Mohs surgery (CPT codes 17311-17315). Intermediate and complex repair codes may be reported with excision of benign lesions (CPT codes 11401-11406, 11421-11426, 11441-11471) and excision of malignant lesions (CPT codes 11600-11646). Wound repair codes (CPT codes 12001-13153) shall not be reported with excisions of benign lesions with an excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440).
Click to expand...
how can I look that up? there is so much information in the NCCI manual, I want to be able to show this to the provider and I think I've clicked on every link but the right one
 
Slraheb said:
how can I look that up? there is so much information in the NCCI manual, I want to be able to show this to the provider and I think I've clicked on every link but the right one
Click to expand...
You can find the NCCI manual here: https://www.cms.gov/medicare-medica...cci/ncci-medicare/medicare-ncci-policy-manual

The part I quoted you above can be found in Chapter 3 on the integumentary system codes, section L, paragraph 9 on page III-14. There is a lot of information in the manuals, and it can sometimes require some searching to find what you need, but the more you use it the easier it becomes.
 
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