Wiki multiple shave bx/lesion destruction

[tlwhlw]

After pathology report received, I coded the following for a Medicare patient:

17000 -59, dx 238.2 (Medicare automatically added Mod 51)
11310, dx 702.19, 698.9, 701.9; with Mod GA --R Face
11300, dx 692.9, 698.9; with Mod GA -- L Leg

There was no office visit charge; no documentation for this.

Medicare has denied most of this claim; has processed as follows:
17000 -- charge amount 74.05, approved 34.30, MC paid pt 27.44, You may be billed 39.4, adjust 7.16 -- surgery reduced because it was performed with another surgery on the same day.
11310 -- charge amount 79.45, approved/MC paid/You may be billed 0 -- Payment is included in another service received on the same day; Your doctor didn't accept assignment for this service. Under federal law, your doctor cannot charge more than $0. If you have already paid more than this amount, you are entitled to a refund from the provider.
11301 -- charge amount 63.69, approved/MC paid 0, You may be billed 63.69 -- The following policies were used when we made this decision; L24361.

Our office is non-par with Medicare, so that patient has paid this in full up front. Is there anything I can do to rebill this to Medicare??? Anything else I should have done?? Medicare is stating we need to reimburse the patient as we have overcharged $39.45. Help!!

Tracy L. Wood, CPC

 

[mitchellde]

I am curious about the 238.2 dx code. You say you coded after the path report so my question then is was that the dx rendered by path and if so then did you destroy the lesion? I am confused. 238.2 is a dx that can only come after path. It does not signify a lesion that the physician has no idea what the path is. If you do a 17000 procedure then the physician must know the dx is a premalignant lesion. Can you provide more information? Such as how many different lesions total were tended to, and which ones were excisied and which were destroyed.

 

[tlwhlw]

Sorry for the confusion....here is a little more info:

17000 was used for cryotherapy for lesion on the forehead, only #1. Doctor dictated as: Skin lesion, unspecified. The lesion on the left forehead will probably resolve with cryotherapy to which patient agreed." This was not sent to path as was destroyed in office.

11310 - right face lesion, shave BX and sent to path

11300 -- left leg lesion, shave BX and sent to path

I have heard in past seminars that 238.2 is okay to use with the 17000 series of codes as a non-specific DX code for these procedure codes. Has this changed???

 

[LCRUZ515]

Procedure code 17000 can only be billed with dx of Actinic Keratosis 702.0. If the physician destroyed a benign lesion on the forehead then i would use 17110 with the 239.2 dx unspecified lesion. 238.2 can only be used after path report comes back and indicates Melonocytic nevus with mild or severe a typia or when uncertain behavior meaning it has cells that can possibly become cancerous but are not yet cancer. The 11310 and 11300 needs to be linked with what ever the path report indicated was the dx. Modifier placement should be as fallows

17000-no modifier
11310-59
11300-59

 

[Lisa Bledsoe]

After pathology report received, I coded the following for a Medicare patient:

17000 -59, dx 238.2 (Medicare automatically added Mod 51)
11310, dx 702.19, 698.9, 701.9; with Mod GA --R Face
11300, dx 692.9, 698.9; with Mod GA -- L Leg

There was no office visit charge; no documentation for this.

Medicare has denied most of this claim; has processed as follows:
17000 -- charge amount 74.05, approved 34.30, MC paid pt 27.44, You may be billed 39.4, adjust 7.16 -- surgery reduced because it was performed with another surgery on the same day.
11310 -- charge amount 79.45, approved/MC paid/You may be billed 0 -- Payment is included in another service received on the same day; Your doctor didn't accept assignment for this service. Under federal law, your doctor cannot charge more than $0. If you have already paid more than this amount, you are entitled to a refund from the provider.
11301 -- charge amount 63.69, approved/MC paid 0, You may be billed 63.69 -- The following policies were used when we made this decision; L24361.

Our office is non-par with Medicare, so that patient has paid this in full up front. Is there anything I can do to rebill this to Medicare??? Anything else I should have done?? Medicare is stating we need to reimburse the patient as we have overcharged $39.45. Help!!

Tracy L. Wood, CPC

First - double check the dx coding and the documentation for procedures. Whether using 17000 or 17110 neither of those codes gets the mod -59 based on cci edits.
If 17000 is the correct procedure (it will require dx 702.0):
17000
11310-59
11300-59
Medicare will reduce the two lower priced codes by half (they don't just reduce by mod -59)
If 17110:
17110
11310-59
11300 (no mod and they will add -51)

Check the fee schedule for your carrier and make sure you are charging the limiting fee. Keep in mind that 2 of your procedures will be reduced by 50% and not necessarily the one you have -59 on.
Good luck! Non-par is confusing I know...we are also non-par.