17000 and 11602: Mutually exclusive: help!

allenm

New
Messages
6
Best answers
0
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 SK considered benign? I tried 11402 (benign) and get the same CCI edit. I even tried using different DX codes - D48.5 (238.2).

The provider did all the work - how do I code to get paid for it? What am I doing wrong?
 

mitchellde

True Blue
Messages
13,535
Location
Columbia, MO
Best answers
2
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 SK considered benign? I tried 11402 (benign) and get the same CCI edit. I even tried using different DX codes - D48.5 (238.2).

The provider did all the work - how do I code to get paid for it? What am I doing wrong?
You could try the XS modifier instead of the 59. Also for the inflamed SK I would use the Z03.89 as the first dx code followed by the L82.1. Z03 codes are first listed only. Also you will need to use the benign excision code since the result was not malignant.
 

CatchTheWind

True Blue
Messages
639
Location
Boca Raton, FL
Best answers
0
There are three problems with the coding:

1) The 59 modifier is on the wrong code; it goes on the excision, not the destruction.
2) The CPT code for destruction of two SKs is 17110, not 17000 & 17003. (17000 can only be used for AKs.) (Report only one 17110, as it includes up to 14 destructions.)
3) As Debra pointed out, an inflamed SK is benign, so you need to use a 114xx code for the excision, not a 116xx.

I disagree about using the Z03.89. I don't believe it is appropriate in this case. (ICD-10 says about the Z03 codes: "This category is to be used when a person without a diagnosis is suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is ruled out.") A patient with a suspicious lesion is not a patent without a diagnosis or signs or symptoms (the diagnosis is "neoplasm of unspecified behavior" and the sign is the lesion). These codes are meant for when a person with no apparent problem at all has been exposed to something toxic or for some other reason is suspected to have some unrevealed problem, and after testing is found to be fine after all.
 
Last edited:

mitchellde

True Blue
Messages
13,535
Location
Columbia, MO
Best answers
2
Neoplasm of uncertain behavior is not a code to be used without the benefit of pathology. The Z03 codes are to be used when a condition is suspected and then ruled out after study. A suspicious lesion is a condition where the provider suspects it could be malignant, in this case this was ruled out by pathology and is now a benign issue. So malignancy was ruled out. This is a perfect example of a Z03 scenario. I use to use V71.1 in ICD-9 but that code did not reproduce exactly so the closest will be the Z03.89. .
 

allenm

New
Messages
6
Best answers
0
Thank you so much! I tried several scenarios. "11402-XS Z03.89, L82.0 and 17110-59, L82.1" was the magic combination to make the CCI edit alert disappear. That was just to push it beyond the Epic barriers. I'll have to wait to see how the insurance company feels. I had never used modifier XS and didn't know 17000 was for AK only, not SK. Always a learning experience!
 
Messages
4
Best answers
0
Hello,
after reading through the question and responses I have a few hints;

You would not use a 17110 on a Seborrheic Keratosis. It must have medical necessity, I.e. inflamed seborrheic keratosis to treat. If there is no itching, irritation, bleeding, etc, etc, you would not have any reason to remove it.

As far as the 17000, is definitely only used for "Premalignant destructions" so the ONLY diagnosis code that is appropriate is L57.0 which is Actinic Keratosis.

Also, if you have 3 procedures and to use multiple surgery modifiers, you would use XS for each.

I hope this helps!
 

Susan

Expert
Messages
463
Location
Chandler, AZ
Best answers
0
I disagree. You do not use XS (or 59) on the primary code.

Not to be mean, but there are many times that one needs to submit the modifier on the first listed CPT code due to RVUs. In our coding brain we don't consider it, just like our coder brain would never put a modifier on a add-on code; in the billing part of our brain to be paid appropriately we have to use modifier -XS or -59 or we won't get paid.
 

CatchTheWind

True Blue
Messages
639
Location
Boca Raton, FL
Best answers
0
you misunderstood

Susan, you misunderstood. When I wrote "the primary code" (and when CodingKing wrote "the column 1 code"), we were referring to the code that is considered primary by CCI rules, not the one listed first on the claim or the one with the highest RVUs.
 
Top