Wiki 17312 the next day...

[pinkfloyd1]

Anyone else have patients return the next day after a Mohs procedure for an additional layer? I have billed this to Medicare as 17312-58 because it is a planned staged procedure. Of course it was denied because it is an add-on code, but re-billing 17311 the next day (as suggested by the lady at Medicare) seens fraudulent. How do you bill in this situation?

 

[FTessaBartels]

Why do you think 17311 is fraudulent?

Why do you think coding 17311 is fraudulent?
Each day's procedure stands alone.

Can't tell you what is correct without actually seeing the procedure note, but it seems that the advice you got from Medicare may be correct.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[pinkfloyd1]

The work involved in taking a second stage layer is significantly less than the first Mohs layer. No tumor debulking is done and since it is a part of the original procedure, a staged procedure modifier seemed correct to me. In retrospect, I wonder if I should have held the original claim and adjusted the units on it to reflect both dates of service. But that doesn't feel exactly accurate either....

 

[MaryG215]

Proper Coding

We had the same question approximately two years ago....A very reliable source who works with and used to work for Medicare said "you must start all over again with your sequence on day two" so basically, day one is 17311, day two would also be 17311 and 17312....hope this helps.