CMS denying physician billing of 97597 and 97598

lang09

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2011 CPT updated description of selective debridement codes. 97597 is for the first 20 sq cm of debridement and 97598 is for each additional 20 sq cm. 97598 has now become an "add on " code. In 2010 you could not bill these codes together -now you have to in order to get paid properly by medicare.

Problem - CMS has not updated the LCDs and they are denying all my claims when I bill 97597 and 97598 together - denial says cannot bill codes together. AND if I bill more than 1 unit of 97598 (which you can do in 2011) THAT denies as CO 151- " exceeds allowed frequency".

Anyone else having this problem? I guess I have to write formal re-determination letters.
 

311wn

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denials of 97597 and 97598

MEU's for first quarter 2011 are posted as one unit of 97597 and 97598.
Therefore, they consider more than 40 sq. cm as medically unlikely.

Plus I understand there is an error with the NCCI edits showing the two codes as bundled.
As coders we know one is an add-on but it's a glitch that needs to be addressed. I also understand that these will not be automatically reprocessed once the glitch is corrected.
So start a list...

Needless to say, Medicare and the 2011 CPT codes are far from in sync to start 2011.
At this time I'm finding no direction for the 11042-11047 debridement codes for large
wounds.
 

nilamdesale

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97597 getting deny for no. units exceeds?

97597 getting deny for no. units exceeds? can any body tell me why it gets deny? Whta should i do??:confused:
 
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