Wiki multiple lesion excisions

[maebelle@gmail.com]

I am having denials from Medicare for multiple (3) lesion excisions. Each excision was coded with CPT 11641. Medicare denied for invalid # of units. Initially it was filed on 3 separate lines with modifier 76 on the last 2 lines. We then refiled on one line with 3 units. Each time, Medicare denied for invalid # of units and we were told when we called that Medicare will only allow 2 excisions at a time. Has anyone else experienced denials from Medicare for this reason and what did you do? We can't control the number of lesions a patient needs to have removed so this just doesn't seem right to me. Thanks in advance for any advice!

 

[markford]

The correct billing for for 3 incisions on the the same date of service would be 11641, 11641-51, 11641-51. The 76 mosifier is for repeat procedures done on subsequent dates of service, not the same date of service.

 

[mitchellde]

Actually the 51 modifier will not keep the additional services from denying you will need the XS or 59 modifier. What dx code was used for these excisions?

 

[emtheis]

Medically Unlikely Edit (MUE) : is 2 for that cpt code.

 

[Candice_Fenildo]

Michelle is correct Marybell, you would have to append -59 on the claim and most likely send in records.