donnaevans
Guest
MCR is giving a MUE denial code for 11101. How can that be when the add on code 11101 has no MUE. This was billed 11100 x1 and 11101x21.
Anyone else having this problem
Anyone else having this problem
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Wiki Denial of 11101 - MCR is giving a MUE denial code for 11101
- Thread starter donnaevans
- Start date
mitchellde
True Blue
your provider performed 22 biopsies? remember a biopsy indicates only a piece of a lesion is being removed and submitted to path. What dx code did you use? There is more to this denial than just MUE.
donnaevans
Guest
11101 denial
Thank you for your response. This was the only visit pt had with derm and samples taken from different locations. Excellent documentation, I did notice that the DX was 709.9 instead of 238.2 which would have caused a DX denial but this was a MUE denial and we are puzzeled. Has anyone else had this problem?
Thank you for your response. This was the only visit pt had with derm and samples taken from different locations. Excellent documentation, I did notice that the DX was 709.9 instead of 238.2 which would have caused a DX denial but this was a MUE denial and we are puzzeled. Has anyone else had this problem?
donnaevans
Guest
11101 denial
Thank you for your response. This was the only visit pt had with derm and samples taken from different locations. Excellent documentation, I did notice that the DX was 709.9 instead of 238.2 which would have caused a DX denial but this was a MUE denial and we are puzzeled. Has anyone else had this problem?
Here is the denials from medicare
N362 The number of Days or Units of Service exceeds our acceptable maximum
Co-151 Payment adjustd because the payer deems the information submitted does not support this many services.
This was appealed once with documentation and pictures of all the biopsied sites. Only one sample from each site.
Thank you for your response. This was the only visit pt had with derm and samples taken from different locations. Excellent documentation, I did notice that the DX was 709.9 instead of 238.2 which would have caused a DX denial but this was a MUE denial and we are puzzeled. Has anyone else had this problem?
Here is the denials from medicare
N362 The number of Days or Units of Service exceeds our acceptable maximum
Co-151 Payment adjustd because the payer deems the information submitted does not support this many services.
This was appealed once with documentation and pictures of all the biopsied sites. Only one sample from each site.
mitchellde
True Blue
No the dx code is correct do not use the 238.2 without a path report.
However we always have to bill separate line items as the 11001 has a maximum allowable of 1 unit per line item. Each biopsy was a distinct and separate area so list them separate using the 59 modifier. It is how I have always billed these and I have never had them deny for any reason.
However we always have to bill separate line items as the 11001 has a maximum allowable of 1 unit per line item. Each biopsy was a distinct and separate area so list them separate using the 59 modifier. It is how I have always billed these and I have never had them deny for any reason.
donnaevans
Guest
11101
The 11100 is the primary Biopsy code billed with one unit. The 11101 is the add on code for additional units. You do not add modifiers to add on codes.
This was taken from the 2009 answer book
"Skin biopsies work this way: You bill the first biopsy using 11100, but if other skin biopsies are obtained during the same session, you bill each additional one using 11101 and putting the number of additional biopsies in the units box. For example, if the surgeon performed 15 biopsies (which is not all that unusual), bill 11100 and 11101 x 14. Modifier 51 is unnecessary."
MUE for 11100 is one but there is no MUE for this add on code 11101, that is why I can't figure out why it's denied. How can you have an MUE denial when there is no MUE? I've done derm for 8 years and this is the first time I've seen this.
The 11100 is the primary Biopsy code billed with one unit. The 11101 is the add on code for additional units. You do not add modifiers to add on codes.
This was taken from the 2009 answer book
"Skin biopsies work this way: You bill the first biopsy using 11100, but if other skin biopsies are obtained during the same session, you bill each additional one using 11101 and putting the number of additional biopsies in the units box. For example, if the surgeon performed 15 biopsies (which is not all that unusual), bill 11100 and 11101 x 14. Modifier 51 is unnecessary."
MUE for 11100 is one but there is no MUE for this add on code 11101, that is why I can't figure out why it's denied. How can you have an MUE denial when there is no MUE? I've done derm for 8 years and this is the first time I've seen this.
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mitchellde
True Blue
add on codes are not exempt from modifiers, they are only exempt from the 51, you do need to add the 59. The answer book states to bill each additional one which is a separate line item for each one, if you do not use the 59 modifier then the second and subsequent do deny as duplicates.
donnaevans
Guest
"Answer Books
Year: 2009
Issue: January 28
Title: Biopsies / Biopsy vs other skin removal procedures
Body: The following table illustrates how skin biopsy codes differ from other skin removal codes in the integumentary section:
Type of Integumentary Procedure Code
Biopsy 11100-Single biopsy only
Biopsy 11101-Add-on code, each additional biopsy Use units box. Do not use modifier 59"
Year: 2009
Issue: January 28
Title: Biopsies / Biopsy vs other skin removal procedures
Body: The following table illustrates how skin biopsy codes differ from other skin removal codes in the integumentary section:
Type of Integumentary Procedure Code
Biopsy 11100-Single biopsy only
Biopsy 11101-Add-on code, each additional biopsy Use units box. Do not use modifier 59"
mitchellde
True Blue
I understand that is what the answer book says, however the code states to list separately and that is how I have always listed them. Where I have worked with these extensively , using units great than 1 always gets a denial, listing multiple lines has always been paid.
1CatchTheWind1
Guest
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11101 denial
mitchellde, do you have a source for your statement that "11001 has a maximum allowable of 1 unit per line item"? (You said "the code states...," but where? - it's not in the CPT book.) I have never heard of this. I have always billed this code (and all add-on codes, such as 17003) as multiple units on a single line, and never had a problem.
Also, I would use 238.2 as the diagnosis if the biopsies were performed on lesions (as opposed to a rash or fungus or something).
I suspect the issue is that Medicare probably considers it "unlikely" for a patient to have 22 biopsies on one day! ("Unlikely" doesn't mean impossible - Medicare describes MUE as "the maximum units of service that a provider would report *under most circumstances* for a single beneficiary on a single date of service." (See http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html)
By the way, just because the MUE isn't published, that doesn't mean it doesn't exist. See same link, where it says: "Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and CMS Contractors' use only."
mitchellde, do you have a source for your statement that "11001 has a maximum allowable of 1 unit per line item"? (You said "the code states...," but where? - it's not in the CPT book.) I have never heard of this. I have always billed this code (and all add-on codes, such as 17003) as multiple units on a single line, and never had a problem.
Also, I would use 238.2 as the diagnosis if the biopsies were performed on lesions (as opposed to a rash or fungus or something).
I suspect the issue is that Medicare probably considers it "unlikely" for a patient to have 22 biopsies on one day! ("Unlikely" doesn't mean impossible - Medicare describes MUE as "the maximum units of service that a provider would report *under most circumstances* for a single beneficiary on a single date of service." (See http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html)
By the way, just because the MUE isn't published, that doesn't mean it doesn't exist. See same link, where it says: "Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and CMS Contractors' use only."