Wiki 17272 Issue

[Coder4Ever123]

I am having an issue with Medicare denying second 17272 lines for several of my patients. I have tried sending the claims with two line items, with one line item with a quantity of two, but each time one of the units is denied as a duplicate. As far as I know, more than one unit can be billed for 17272. Would anyone happen to know anything about this? Does it need a special modifier or can we only bill one quantity per day?

 

[iowagirl77]

If they have the same dx, I'd bill 17272 x2 on one line. If they have different dx, I'd bill 17272 x1, 17272-XS x1 and link the separate dx. If it still denies as a duplicate, I'd appeal with records. As far as I know, there isn't an MUE issue with just 2 units, but you can double check. I'm having issues pulling it up.

 

[thomas7331]

I am having an issue with Medicare denying second 17272 lines for several of my patients. I have tried sending the claims with two line items, with one line item with a quantity of two, but each time one of the units is denied as a duplicate. As far as I know, more than one unit can be billed for 17272. Would anyone happen to know anything about this? Does it need a special modifier or can we only bill one quantity per day?

The Medicare contractors I've worked with have never accepted multiple units on surgical codes (unless they are add-on codes, which this one isn't). You would need to bill it on two lines with a modifier (e.g. 59 or XS) on the second line to indicate that it's a separate procedure and not a duplicate.

However, if you've already submitted multiple claims and have had one of these paid, then it might be difficult to get the second one paid because once you have several charges in the Medicare system for the same code, it becomes difficult for the claims processors to be able to know which ones are duplicates and which ones are actually supposed to be paid. I would suggest submitting your second charge alone with the appropriate modifier, and if it still denies, you may need to speak to a rep on the phone or submit a written request with notes to have the payments reviewed.