Wiki TISSUE TRANSFER ADD-ON 14302 MULTIPLE QUANITY

[mkndevh@msn.com]

Hello. Does anyone know how large multiple quantities of 14302 are billed? It was a very large area (800 sq cm) with 25 units (14301 first 60). I know that each payor has a max allowable quantity. Would it be billed 14302, 14302-59 x 24 (or allowable qty) or 14302, 14302-59 on separate lines for each unit? I'm brand new to plastic coding, so any guidance is appreciated.
Thank you.

 

[Orthocoderpgu]

Code 14302 is an "Add-on" code and as such does not need a -59 modifier. Most payers should allow this on one line with the number of units for the size. It also has an MUE OF 8, so if you have to report it more than 8 times you will have to submit documentation and appeal the additional units.

 

[thomas7331]

In the early days of the edits for maximum allowable units, you used to be able to bypass the edits by splitting the units onto multiple lines like this, but in my experience, most payers nowadays have claims systems and post-payment audit technology that is sophisticated enough to detect this and they will still deny your excess units even if you bill this way. However, if your documentation clearly supports the units that you have billed and the services are reasonable and medically necessary for the condition being treated, then it is usually a very simple matter to submit the documentation and overturn the denial in this situation.

 

[trarut]

It's been my experience that most plans follow CMS for MUE's. CMS shows an MUE of 8 for 14302. Some payers do have specific instructions for submitting line items with units exceeding the MUEs. Check the payer for this claim for a frequency policy, usually with the reimbursement policies. If you can't find one, it may be worth it to call Customer Service and explain what you're looking for. They probably won't tell you how to submit but may be able to point you to the correct policy. If you know what their rules are from the onset and can submit following their guidelines, you may just get pended for a pre-pay records review and be lucky enough to get paid without having to be denied and appeal.

CPT identifies the code as an add-on and not requiring a 59 modifier but the payers set their own rules. We run into it all the time with drug administration add-on codes. If you don't already know this payer requires a 59 modifier, find the payer's policy for bundling and/or add-on codes and see what they advise.

 

[mkndevh@msn.com]

Thank you!