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Wiki Billing Keloid Injections for several sites

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riverside23

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I have a patient whom my doctor did over 35 steroid injections with patient under anesthesia. I billed 11901, 11901-59, 11901-59, 11901-59, 11901-59. BCBS paid the first code for only $35! Any input on how to get the most reimbursement for this???? Did I code wrong??
 
Yes, you've coded this incorrectly. If you'll review your CPT code descriptor for 11901, you'll see that this code is for '8 or more' lesions, not for 'each 8' lesions. CPT 11900 is assigned when fewer than 8 lesions are treated; 11901 when more than 8 lesions are treated.

If your provider has documented that the treatment of 35 lesions involved significantly more work or time than normally involved when treating more than 8 lesions in a single encounter, then you might consider appending modifier 22 to code and requesting additional reimbursement from the payer. However, I'd caution that I think it's unlikely that a payer would allow additional payment because 11901 is already valued to reimburse work across typical provider encounters which may involve different number of lesions. In other words, your provider is being paid a per-visit rate, not a per-lesion rate, for this type of service.
 
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Oh okay I understand. So what your saying is I can submit with code 11901-22 and see if they will pay at a higher rate? I just want to make sure I understand correctly. This is such little amount for the work done..
 
riverside23 said:
Oh okay I understand. So what your saying is I can submit with code 11901-22 and see if they will pay at a higher rate? I just want to make sure I understand correctly. This is such little amount for the work done..
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Yes, you can try that. You usually have to submit notes with the claim to get the extra payment, but you should check your payer's policies for additional information. But often, it's only a 20% additional payment, so it may not be worth the trouble even for a service that reimburses as little as this.
 
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