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miranda.jones

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I just started at a dermatology practice 3 weeks ago, and I'm brand new to this specialty. We are getting denials and don't understand why because I'm not familiar with the codes. Does anyone have any suggestions on any books or sites to familarize myself with the basics of dermatology do's and dont's?
:confused:
 
Miranda;

I found just using my CPT book was helpful, in addition to calling the carriers and asking why on the denials.

Is there a particular issue you are having that I might be able to help you with? Let me know.
 
what carriers are you getting denials from and for what codes? there are alot of issues that require modifier 59 on different site lesions if you are doing more than one procedure
 
Denial

Thanks for responding. I work for a dermopathologist and these are the two claims we filed for the new pt.

For example on a denial from United Medical Resources (TIN Based Payer)

female dob 11.05.68 / DOS 09.29.08

1st claim
11401-51 dx 238.2 paid
12031-59 dx 238.2 paid
11301-59 51 dx 238.2 denied as global
11301-59 51 dx 238.2 denied as global
99203- 25 dx 216.3, 216.6, and 216.7 paid

2nd claim
88305 - 59 dx 216.5 paid
88305 - 59 dx 216.7 paid
88305 - 59 dx 216.7 paid
 
miranda.jones said:
Thanks for responding. I work for a dermopathologist and these are the two claims we filed for the new pt.

For example on a denial from United Medical Resources (TIN Based Payer)

female dob 11.05.68 / DOS 09.29.08

1st claim
11401-51 dx 238.2 paid
12031-59 dx 238.2 paid
11301-59 51 dx 238.2 denied as global
11301-59 51 dx 238.2 denied as global
99203- 25 dx 216.3, 216.6, and 216.7 paid

2nd claim
88305 - 59 dx 216.5 paid
88305 - 59 dx 216.7 paid
88305 - 59 dx 216.7 paid
Click to expand...


Ok here we go....
Where did your 216.x's come from if everything else actually came up dysplastic? Be sure you are not using 238.2 without a pathology report to support the lesion as being dysplastic. If you are not sure you should be using 239.2.

Since you have two shave biopsies of the same size and location, I would appeal to your carrier with documentation to support your billing.

Let me know how it turns out.
 
Why is the 59 modifier on 12031? Since this is the highest RVU code, wouldn't it be your primary procedure and wouldn't need a modifier? The others would need a 59 to show that they are the ones that were separately identifiable from that one? Though actually I don't see any CCI edits between any of these codes but do payers bundle them anyway? I don't do much derm and would like to learn more. Thanks for your help.
 
Herbie,

You are correct. The only thing that you need a modifier on is the E&M. Miranda you should look into getting a software called claim check. It is specificaly for dermatology billing. It basically tells you what modifiers go on what codes. You just enter the codes and click a botton it is great. It coinsides with medicare cci edits so that your codes don't bundle.
 
MSO Claims Business Analyst

? I have Dermatologist submitting claims with cpt codes 14041 Modif 79 & 59
17312 79 59, 17311 79 59, 14041 79, 14041 79 59 these are all on the same claims with Dx of 173.3

Please Help



Thank you

Kelly
 
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