Wiki Help! Coding multiple malignant lesion destructions (payer vs CPT)

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kculter

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Scenario I have a question about: multiple malignant lesions of the same size in the same body area that are destructed during the same visit (all lesions fit the same destruction code).

Should this be done as separate line items/codes for each lesion on the claim form? (this is how the coders here interpret the CPT guidelines as the correct way)
Billing it this way to BCBS medadvantage got a denial (2 of the same code w/ -59 on second one), and an insurance rep told one of our billers that we should report one line item/code with multiple units to represent the multiple lesions.
One of our supervisors agrees with this, stating that insurance won't pay it when the lesions are "listed separately" like we had billed it.

What are anyone's thoughts on multiple line items vs multiple units? There is different interpretation of coding guidelines going on here, and we want to code correctly despite what may cause something to be paid.
As I watch coding webinars I hear "check with your payers" a lot as far as clarifying billing guidelines for procedures, and I'm trying to figure out where the line is for what's correct here and what the payer wants.
When do payer guidelines take precedence? Or is our interpretation of separately listed line items/codes correct here?

Thank you!
 
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Medicare does not allow multiple units on surgical CPT codes (except for add-on codes), and in my experience most commercial also do not, so I don't recommend billing this way.

I think you've billed correctly using multiple lines and the 59 modifier (I disagree with your supervisor on this) and in my opinion it should not have been denied. But this particular payer may require a different modifier - I've heard that some prefer modifier 76 instead of 59 if you're repeating the same CPT code, or they may want the more specific X- modifiers - you would need to review their policies. Or it also could just be a processing error and you may need to appeal or request that the denial be reviewed.
 
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thomas7331 said:
Medicare does not allow multiple units on surgical CPT codes (except for add-on codes), and in my experience most commercial also do not, so I don't recommend billing this way.

I think you've billed correctly using multiple lines and the 59 modifier (I disagree with your supervisor on this) and in my opinion it should not have been denied. But this particular payer may require a different modifier - I've heard that some prefer modifier 76 instead of 59 if you're repeating the same CPT code, or they may want the more specific X- modifiers - you would need to review their policies. Or it also could just be a processing error and you may need to appeal or request that the denial be reviewed.
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Thank you!
 
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