1. S

    Low vs. Moderate Risk of Morbidity

    Does anyone have any examples of what would distinguish a low vs. a moderate risk of morbidity? It seems so subjective.
  2. S

    Wiki Code 11102 + 11103 Denying Under Physician's Assistant

    Medicaid plan through Banner University Family Complete Care is denying codes 11102 + 11103 with a PA on the claim stating "99353 AHCCCS P353: PROVIDER TYPE NOT ELIGIBLE." The claim pays however when we resubmit under an MD as opposed to the PA originally on the claim. This issue began in Jan of...
  3. S

    Wiki Anyone have any experience coding laser?

    Hi. My provider wants to file insurance for resurfacing a scar with a YAG laser. Anyone have any experience with this? We used 17999 but the reimbursment is way to low and she will be losing money for these treatments. THanks
  4. J

    Wiki NMD billing as MD

    Hello! I have a quick question: Our practice is intending on bringing an NMD (Naturopathic Doctor) into the practice and have them see patients as their service provider, but have the billing provider listed as an MD. [It's basically two doctors seeing a patient in one visit, with the NMD...
  5. J

    Biopsy Coding: Incisional vs. Punch vs. Shave

    Hello! I would like to kindly inquire regarding the proper coding for biopsy, especially if there is more than one type of biopsy done during a patient's single visit. The scenario will be as follows: Scenario One: Patient came in for a visit, and ended up having one punch biopsy and two...
  6. K

    Wiki 11102 & 17110 for same lesion?

    We have a provider that did a shave biopsy on part of a lesion then on the rest used liquid nitrogen. I am unable to find any resources regarding 2 different techniques for the same lesion. I am leaning towards both can't be billed, however, this provider needs explanation/proof as to why. Any...
  7. J

    Question Appropriate modifier for CPT 13122 and 17311

    Good morning everyone! I have a quick question regarding these three CPT codes. Pt came in for a MOHS procedure, as well as a complex repair afterwards. The following CPT codes were used: 13122 17312 17311 Initially, modifier 51 was used on 13122, however it was denied by UHC. Replaced it with...
  8. J

    Wiki Claim Denial: Mutually Exclusive Procedures

    Hello, everyone! I am not sure if this is posted yet. But I have a quick question regarding denials and appeals for California. Recently, we have had a denial for mutually exclusive procedures: unbundling for the codes as follows: 17000 - L57.0 AKs 17003 - L57.0 AKs 17110 - B07.00 Plantar...
  9. C

    Coding Warts

    Hi! Our PA saw a patient that is being treated for warts and within it is a callus. they did pare and cut the callus in order to treat the wart. My question is can I bill for the pare and cut of callus separately from the wart tx or is it included in the wart treatment? Thank you!
  10. J

    Question: MOHS Surgery Question

    Hello everyone! I have a quick question regarding MOHS. The case is as follows: Patient came in on day xx to have staged MOHS(I-III) procedure done on him due to BCC dx. Codes 17311 and 17312 was used. However, upon further examination, provider found out that there is still residual tumor...
  11. Q

    Wiki Risk of Complications/Morbidity of Patient Management- Minimal vs Low?

    These are the only two categories for which examples are not provided in the MDM table. We have Dermatology providers who regularly choose 99203/99213 for benign skin exams. The MDM notes regularly look like this: Findings: benign nevi, solar lentigines, cherries - sun protection/avoidance -...
  12. J

    Wiki E/M Personal History of Skin Cancer

    Our office is discussing E/M levels for patients with personal history of skin cancers. These patients are coming in annually/biannually and some are only seen for their history of skin cancer, is this considered a chronic condition? Our coders are back and forth with coding these as 99212 or 99213.
  13. N

    Wiki Multiple Procedures

    Patient presents for neoplasm of uncertain behavior x3 left lateral and medial canthi and upper eyelid. left lateral canthus: 2.5mm x 2.0 mm, intermediate repair left medial canthus: 2.0 mm, intermediate repair upper left eyelid margin punctured w/ sharp and drained of fluid 2 biopsies sent...
  14. L

    Wiki Multiple Claims in 1 Day

    I'm taking over the Compliance portion for a small Dermatology Office. Right now the provider will submit MOHs on one claim, but then submit the biopsy on a different claim that gets signed off a week or more later. And another provider will chart and bill for the closures. This is causing...
  15. J

    Wiki Blue Cross Blue Shield of IL lesion removal denials due to bundled

    Hi, just wondering if anyone has been experiencing denials from Blue Cross when the claim includes a shave removal (eg. 11300) on one site and destruction of lesion using liquid nitrogen on another site (17000 or 17003) with two different diagnosis codes and a 59 modifier on the 17000/17003. We...
  16. L

    D22.5 and D22.39 coded togther on OV?

    We had some claims rejected by IBX (we are in PA) and when we called they said they were denied because the provider coded D22.5 (nevus on trunk) and D22.39 (nevus on face) both on the Office visit 99213. They said those codes cannot be used together. Dr states pt came in for DN on the trunk...
  17. M

    Wiki multiple procedures-ASC coding question

    Where would you apply modifiers to these codes in the ASC setting? Only the 13132 paid. This is an Aetna claim. The denial does state the codes denied for the charges included in the contracted and/or case rate so I'm not sure if that's referring to a grouper for the ASC..? 11402 11442 13120...
  18. J

    Questions on coding procedures

    Thank you in advance! I have a couple of questions related to procedure coding for dermatology. If anyone is able to answer these, it would be greatly appreciated! 1. For scar revision after an excision of malignant lesion due to the scar not healing properly, is a benign excision also billed...
  19. S

    Interpolation Flap--documentation requirements. Is this enough

    Hello, Wondering about this closure documentation. This scenario is for MOHS, for BCC on the right helix, with closure same day, this is all on one note. At first, all it said was "Closure, Interpolation repair." Then it was corrected to say the following: "Because of the size, location, and...
  20. S

    Wiki Dermatology- Is this area considered the LIPS or the FACE?

    Hello, Looking for clarification on this location please. When coding dx and procedures on the area of skin directly under the nose, not touching the actual lip or lip border at all, is this still considered the "upper lip" or "other part of face?" I know code choices will differ depending on...
  21. S

    Scissor snip biopsy or removal, multiple specimens, path is not skin tag.

    Hello, Our staff comes across this type of note daily, and would like some clarification on what is the proper way to bill this scenario? Thank you in advance. Note copied below: Dx given in note as D49.2 and skin tags. Scissor Snip biopsy Left axilla x4, Right axilla x3, Groin IFEP. The area...
  22. A

    17260 Total Treatment diameter vs. lesion size? HELP

    Help! I have a dermatology provider who is always billing for malignant destruction lesions. She will document in her note something like this: The lesion was then prepped with chlorhexidine, and anesthetized with buffered 1 % lidocaine with epinephrine, followed by electrodesiccation and...
  23. R

    Wiki Hyperhidrosis - Billing for Botox

    We treated a patient with hyperhidrosis with Botox and billed Aetna cpt codes 64650 & 64653 which were paid. we also billed J0585 @ 200 units which Aetna ultimately denied. The patients plan requires that they get the Botox through their pharmacy, so our office is not supplying the botox. Should...
  24. S

    2019 Biopsy codes. 69100, 11102 and 11103

    Hello, I am trying to bill a left ear biopsy (69100) along with two shave biopsies (11102+11103). I am getting an edit requesting for a modifier to be put on the add-on code of 11103, because it is butting up against 69100. I was under the impression add-on codes do not require modifiers. Am...
  25. C

    Health Care Provider Taxonomy or Characteristics Code Set Question

    I understand that the selection of a taxonomy is not contingent upon any certification or license. As taxonomy codes have evolved and the list has expanded, is there a best practice or guiding principle in selection? Are publications available that reference CMS crosswalk, payer claim impact and...
  26. J

    CPT 11102 & 11103 denying as in global/apart of another procedure

    Hello, I have a few claims from particularly Premera and Amerigroup - but they are denying CPT codes 11102 & 11103 when billed together, even with no office visit or other procedure. I called in to ask and I am told there is a CCI edit but I find no edits between these two codes. Is anyone else...
  27. C

    clarification of 10140 vs 10060

    This has been a long-standing question here, and I hope someone on the forum has the answer: Since 10060/10061 are specifically for I&D of "abscess," does that mean that if a cyst is not abscessed, you should use 10140 for I&D of cyst?
  28. K

    New Skin Biopsy Codes

    Is anyone else experiencing issues using the new skin biopsy codes (11102, 11104, 11106 etc) for medicare patients? Our MAC, Palmetto, has put the new biopsy codes under their LCD for Removal of Benign and Malignant Skin Lesions. This seems like a bit of an oxymoron. By that I mean, a biopsy...
  29. L

    Denial 11755 modifer issue Cross Posted

    I also posted this in the modifier forum but here is the issue patient was seen for a full skin with hx etc 99213 it was paid the second item on there was 11755 a bx of the nail it was denied for incorrect modifier using a 59. IBC the payor recommended taking off modifier we did that they...
  30. L

    HELP 11755 denied for wrong modifer-Nail Bx Dermatology

    We have gotten a denial from IBC 2 times now for "wrong modifier" on 11755 billed charges were 99213 OV for Full Skin HX of MM etc 25 modifier(went thru and paid) 11755-bx of nail (billed with 59 modifier and denied then billed without modifier as suggested and denied.) So what modifier would...
  31. A

    lateral/medial canthus ICD-10

    With the new ICD-10 codes for 2019, we are now required to specify if a lesion is on the upper or lower eyelid. I code for a lot of mohs surgeries on the eyelid and some fall on the 'lateral' or 'medial' canthus. When asking the provider to specify if the lesion is on the upper or lower...
  32. J

    Code for embedded piercing

    One of my providers recently removed an embedded piece of jewelry; the young lady had had her chest pierced, but one end of the hardware came off and the main piece slipped down into the piercing & healed over. 2 years later she decided this was a problem & came for removal. I am coding a...
  33. S

    Counting skin exam elements, Dermatology

    Hello, We are having a debate after an audit and need clarification on counting elements of a skin exam- 97 guidelines. In order to count "head, including face" (as listed on the specialty skin exam) Can just the face be examined for your 1 point, or does it have to document BOTH the head AND...
  34. K

    Palmetto GBA LCD L33445 removal of skin lesions

    Palmetto GBA became our MAC at the beginning of the year. With that comes their LCD L33445 Removal of Benign and Malignant Skin Lesions with (or in this case without) a different set of "covered" or "deemed medically necessary" ICD-10 codes. This has really shook the physicians in terms of...
  35. S

    Risk factor for destruction of lesions?

    Hi, We are having a debate whether destruction of benign or malignant lesions 17000-17110 are considered a *Minor Surgery WITH Identified Risk Factors, or Minor Surgery WITH NO Identified Risk Factors* under the Management Options category when coding EM levels. For example sake, lets say pt...
  36. L

    Oct 1 2017 change to L57.0 code-needs additional code??? HELP

    Hi we are in Pennsylvania we regularly treat and bill L57.0 code under the 17000/17003/17004... I saw in the proposed changes and deletions upcoming is one that states that you need to use an additional code to identify the source of the ultraviolet radiation? We have never had to do that ever...
  37. L

    E/M Dermatology 99212, 99213

    We have had some difference of opinon on how to bill out the E&M lately with new drs on staff vs drs that have been here for years. Generally patient comes in here for a Full Skin exam which may or may not result in some biopsies but mostly the only other things notes are SK's and maybe Acne or...
  38. S

    Modifier 26

    I have a question? When billing for pathology services for a procedure that was done in POS 24 are we to apply the modifier 26? Our office is receiving denials when billing for the services with a global. The denial states that the technical component was covered under the facility charges. When...
  39. D

    Wiki Documentation Requrements for Myocutaneous/Fasciocutaneous Flap (15732)

    Hello, I am hoping someone can help me. I work for a dermatology office that does a lot of Mohs procedures...We have a plastic surgeon that will perform the appropriate closure/repair post Mohs. Only recently some of the commercial insurances (UHC & Aetna) have been denying CPT code 15732...
  40. J

    ICD-10 Code for recurrent physical trauma of skin

    Our LCD says that benign lesion removals (shaves, excisions, skin tags, destruction) will be covered when the "lesion is in an anatomical region subject to recurrent physical trauma and there is documentation that such trauma has in fact occurred." For example, documentation says, "lesion...
  41. L

    11301 shave codes Medicare Denials

    Recently Medicare has been denying procedure codes 11300, 11301 etc... all the shave codes. We have never had an issue in the past not sure what is happening now. They are stating that it is not a covered service. We have sent path reports and physician notes and they still deny. Any insite...
  42. L

    Shave Codes being DENIED by Medicare

    Recently Medicare has been denying procedure codes 11300, 11301 etc... all the shave codes. We have never ha an issue in the past not sure what is happening now. They are stating that it is not a covered service. We have sent path reports and physician notes and they still deny. Any insite...
  43. S

    Resuturing Surgical Wound

    Hello! I have a question about post-op periods and resuturing a wound. A patient in my office had an excision on Wednesday. She had post-op bleeding and ended up the ER all night. The ER sent her back to the office in the morning after they were unable to control the bleeding. The doctor...
  44. A

    17000 and 11602: Mutually exclusive: help!

    Three separate lesions. Two classic SK were frozen and a third suspicious spot was excised. Path report returned inflamed SK. Coded 11602 - L82.0, 17000-59 L82.1 17003 L82.1 I am getting a CCI edit for 17000 and 11602 as mutually exclusive. First question, is inflamed...
  45. L

    Heard of Light Hyfrecation?

    I am auditing a dermatologist who is claiming that he performed "light hyfrecation" on some papules of the face. He is billing 17000 and 17003. I can't even find what this is, must less how to code it. Anybody ever heard of this? Dx for this procedure is 216.3, but primary Dx is Rosacea...
  46. P

    unclear pathology terminology to code excision

    I am coding an excision of lesion on thigh that was on hold for pathology [CPT 12032, 11402]. The path result diagnosis came back as "atypical compound melanocytic nevus". I would code this as dx 216.7 (benign neoplasm, thigh) - however, the pathology states additionally "the findings are...
  47. O

    Seeking Medical Coding position - Richmond, VA

    EMPLOYMENT 2007-Present Billing Specialist, Pediatric Dentistry and Orthodontics  Posting of encounters using CDT codes  Appeal Letters to insurance companies  Paper and Electronic billing of Insurance companies  Reviewing and correcting errors due to posting incorrectly and insurance and...