Wiki 17003 Excessive Units

Create Wiki
E

eeason

Guest
Messages
1
Best answers
0
Our office has been contacted requesting an overpayment refund request (by Connolly on behalf of BCBSNC) stating that we billed 17000 and 17003 x 10 units. Their request states "Per CPT book 17003 covers lesions (2-14) and should be only billed with 1 unit"

Is this not incorrect???
 
eeason said:
Our office has been contacted requesting an overpayment refund request (by Connolly on behalf of BCBSNC) stating that we billed 17000 and 17003 x 10 units. Their request states "Per CPT book 17003 covers lesions (2-14) and should be only billed with 1 unit"

Is this not incorrect???
Click to expand...

You have to appeal this. Tell them to hire someone who can read CPT correctly:)
CPT states: 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion
+17003 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)

As you see 17003 is an add on code and it is billed separatelly for each additional lesions up to 14.
 
It is correct that you cannot bill 17003 X10 units. This would mean the patient had hundreds of lesions destroyed. If there were 10 lesions than you would bill 17000 for the first lesion destroyed and 17003 for the rest up to 14. 17004 is billed alone for 15 or more lesions without the 17000 or 17003. Hope this helps!
 
17003 Excessive units

You need to appeal this and they need to be able to read the CPT book because it specifically says, each and if you look at the net code it does not say each.
 
The word "each" in the description indicates you bill with units for each additional lesion. I'd appeal.
 
Most payers are using this edit now for surgical service billed with units greater than one. i always bill individual line items, the instruct in the book states "list separately....." I have always been paid when I list it as follows
17000
17003
17003 59
17003 59
17003 59
17003 59
17003 59
17003 59
17003 59
17003 59
17003 59
This shows that 10 independent and separate lesions were destroyed in the same session.
 
jgf-CPC said:
It is correct that you cannot bill 17003 X10 units. This would mean the patient had hundreds of lesions destroyed. If there were 10 lesions than you would bill 17000 for the first lesion destroyed and 17003 for the rest up to 14. 17004 is billed alone for 15 or more lesions without the 17000 or 17003. Hope this helps!
Click to expand...

Please read the CPT book CORRECTLY. I hope you have not been billing like this for your employer.. if so they have lost countless money.
 
Just new at this and had the same question. On the AAPC practice exam A and others, excessive units that have in the description "second through 14 lesions, EACH (List separately in addition to code for the first lesion". The answer to one of the questions on the exam show destruction of multiple lesions and is coded as follows: 17000 lesion one; 17003 x 10 for a total of 11 lesions. If you are billing 17000 +17003 thinking that 17003 covers everything, then you have been grossly underpaid. The company requesting the refund needs to call the AMA for clarification as they aren't going to listen to the person they think made a mistake. Just my two cents, 8 years later!!
 
Carol Buck's book states If the patient had six lesions removed, the first one would be reported with 17000 and lesions two through six are reported with 17003 x 5.

Cathy
 
You must log in or register to reply here.
Top