Wiki Lesion Coding

[amckinney@camashealth.com]

We have noticed our CBO is writting off lesion removal under 17110, & 17111. We started utilizing the LCD from CMS for coding of these lesion removals with the appropiate diagnosis codes and still seeing them written off. We have been told to bill 17110 for the fist 14 lesions and for any addtional up to 29 lesions to bill 17111 with modifier 59 or if over 14 lesions to just bill 17111 that we are seeing these written off as well.

With the LCD we are applying the appropiate diagnosis codes for the lesion removal in the first position and if more we add those as second, third, ect on those lines of service. Doctor does use a laser or sugcial curettment. Would appreciate any assistance on this as we do not want to have these written off.

 

[thomas7331]

You should review the CPT descriptions of these codes. If you are billing 17111 with modifier 59 in addition to 17110, then you are billing incorrectly. 17110 is for treatment of up to 14 lesions, not for 'the first 14 lesions'. 17111 is for treatment of more than 14 lesions. You would use one or the other code, not both. It's not correct to use CPT code 17111 for 'any additional up to 29 lesions'.

As for the charges that are being written off, I think you need to start by talking with your CBO and get more information about that. Charges may be written off for many different reasons, some of which may have nothing to do with the LCDs. You'll need to get specific examples and look at the claims, the reason for the denials, and the CBO's reason for writing them off. There are too many possible scenarios involved here to be able to help you without being able to see your claims.

 

[sls314]

Agree with what thomas said.

Also, I'd add that the NCCI edit between 17110 and 17111 does not allow a modifier to override. Adding a 59 modifier will not make both codes payable.

If you need more education on NCCI edits, the CMS website has a wealth of information about NCCI edits and when it is (or isn't) appropriate to use Modifier 59 or the X modifiers. Here's the main CMS NCCI edit page - there are a lot of different documents you can navigate to: https://www.cms.gov/medicare-medica...-correct-coding-initiative-ncci/ncci-medicare

Regarding the CBO write-offs...if you're putting 17110 and 17111 together on a claim, that will necessitate an adjustment of some sort. Those two codes will never be payable on the same claim, so the CBO has to do something with the unpaid line. An unpayable charge can't sit on the books forever.

The best way to reduce the write-offs would be to bill the claim correctly with either 17110 or 17111 (but not both on the same claim).

Hope this helps!