Wiki Medicare - Destruction

[Sarahp941]

Hey! I am finding a mass denial and recoupment requests from Medicare (only) for Destruction codes 17000, 17110, 17111. I pulled the LCD Guidelines and we are coding it correctly. However, I noticed that many of the patient had these procedures done in the past, whether recent, within the year, or last year. Is anyone else noticing a trend or can anyone help me with ideas on why this may be happening? Thanks in advance

 

[ellzeycoding]

Appeal it. 17000/17003 should be billed with L57.0 and there is a National Coverage Determination policy NCD 250.4 that says these are covered without restriction.

https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCAId=238&NcaName=Allogeneic+Hematopoietic+Stem+Cell+Transplantation+(HSCT)+for+Myelodysplastic+Syndrome&ExpandComments=y&CommentPeriod=0&NCDId=129&ncdver=1&bc=AiAAAAAAIEAAAA%3D%3D&

What codes were billed on the others 17110/17111?

 

[Sarahp941]

Appeal it. 17000/17003 should be billed with L57.0 and there is a National Coverage Determination policy NCD 250.4 that says these are covered without restriction.

https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCAId=238&NcaName=Allogeneic+Hematopoietic+Stem+Cell+Transplantation+(HSCT)+for+Myelodysplastic+Syndrome&ExpandComments=y&CommentPeriod=0&NCDId=129&ncdver=1&bc=AiAAAAAAIEAAAA%3D%3D&

What codes were billed on the others 17110/17111?

Majority of the codes were by themselves, with no other codes billed. Some other ones were billed with office visits as there were other issues addressed, like acne or skin tags. But none of the destruction codes were billed with other procedures. I will definitely be appealing them but it was weird that all of a sudden Medicare is recouping. Thanks for you help!

**I have received a few denials this morning from Medicare with the reasoning "Payer deems the information submitted does not support this many frequencies of service".