Wiki Bundling issues 11602 w/ 99213

[tholcomb]

Hello fellow coders,

Procedure below cpt 99213-25,11602,12032 Aetna denying 99213-25 as bundled with 11602 any ideas?

Location - left axilla superifical BCC 12-3125; Lesion Size - 1.0cmx 0.8cm with 4 mm margins

Patient was taken to the outpatient operating room and placed in a comfortable position exposing the surgical site. The borders were highlighted and then an ellipse with several mm borders was marked around using the relaxed skin tension lines as much as possible. The area was prepped and draped in sterile fashion with alcohol, Betadine. 6 ml of Lidocaine 1% with epinephrine was used. The incision made with several mm borders around this defect and the specimen dissected off the mid sub cutis. A score was placed at the superior tip. Tissue was undermined and hemostasis achieved with electrodesiccation. Closure followed with 3.0 PDS in the sub cutis and dermis in buried fashion and steri-strips in skin. Closure length was 3 cm. Pressure dressing placed. The patient tolerated the procedure well without complications.


TH

 

[Pam Warren]

Per the new CCI edits, an E&M with a minor procedure is bundled in, unless the E&M is significant and separately identifiable. The true story is that most payers will not pay both on the same encounter. In your documentation, I see only the procedure; there is no other documentation to support the E&M such that you could bill it with a modifier. Since it was done in the outpatient OR, was this a scheduled procedure? If so, an E&M would be inappropriate for the same problem.

Void out your E&M and bill only the lesion excision and the layered closure.

 

[tholcomb]

Thank you Pam that does make sense since the patient initally came in for the excision the office visit should have not been billed.