17000 Global to +17003??

debrooth

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We just started billing for dermatology, and I could use some help. We are billing the scenario below and Medicare is denying the 17000 as Global. Can anyone tell me what we are doing wrong?

-- 99213-25 (DX V10.83)
-- 17000 Destruction, Premalignant lesions; first lesion; (DX 238.2)

And we are using the add-on codes… for two additional lesions removed….

-- +17003 X1 (DX 238.2)
-- +17003 X1 (DX 238.2)

Thanks to any/all who respond!!

Deb;)

 

daniel

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Just some extra input.

CPT 17000 & 17003 only links up to DX 702.0. I know there's books out there and other coder will tell you differnt. But most insurances and especially medicare links cpt 17000, 17003 with Actinic Keratosis (702.0). So by you using this other DX. With 17000, 17003. That's probably why it's getting kicked back.

Regarding putting X2 next to the 17003. Or billing it twice. As you posted it.
That would be going in the wrong direction. Because there's no need to do that.

CPT 17003 states- second through 14 lesions. It's already in the description for you.

So if you destroy one Actinic Keratosis. Just use. 17000. 702.0
And if you destroy up to 14 lesions. Bill as such.

17000. 702.0 first lesion
17003. 702.0 2nd through 14 lesions.

And if you bill 15 or more Actinic Keratosis, just use 17004 (alone).

After this is all said and done. Redarding your coding scenario you gave. Use cpt 17110 for this case. CPT 17110 pays higher than 17000 anyways. This links to warts, benign neoplasm.

Respectfully
Daniel, CPC
 

dmaec

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if the denial reason is for "global", this service must be falling under some other procedure the patient had. Have they had any other recent procedures that have a global of 10/90 days that "this" service is falling into? If so, your office visit will need modifiers .24.25 on it.
Also, Lisa is correct - to get the 17000/17003 paid you'll need a covered dx and 238.2 isn't one of them!

Daniel is correct also - You might want to check out the 17110 code, it might be the better one to use in your case.

{that's my opinion on the posted matter}
 

smwermter

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In reference to what Daniel was saying...17003 needs to be reported for each of the 2nd through 14th lesions. So, in addition to 17000, 17003 X 2 would be on one line like Lisa was saying. :)
 

daniel

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great answers everyone.

Curious, to those that say you need to add X2, X3, and so on to the 17003 when there's more than just two Actinic Keratosis.

Have you notice higher reimbursement. When you append the X2, X3 and so on, from insurance carriers.

Respectfully
Daniel, CPC
 

Lisa Bledsoe

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Daniel - CPT does state "each" in the description for 17003, so you can and should bill for all lesions x# (until you are at 15 of course). Yes, our payers reimburse for the quantity billed.
 

daniel

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I picked up on something here, by jumping in on this thread. I'll be adding X2, X3 and so on to 17003. When there's more than two AK's. Thanks for the input on this.

Respectfully
Daniel, CPC
 
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