Wiki Dermotology need help

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maynard1

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Lafayette, IN
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Can someone advise me? This is what my Dr. billed to Medicare :
11402 216.6 rejected /bundled
12032 59 216.6 paid
17000 59 702.0 paid paid mulitple proc rule 50%

any idea's on why 11402 would not pay

Thanks
 
The 11402 code requires a 59 modifier when sent with those codes. The dx 216.6 is benign, Medicare does not pay for procedures done with no medical necessity.
 
Ok so you have an excision of an anomoly that path says is benign, correct? and you did an intermediate repair of this excision, correct? and then you did a destruction of a different anomoly, correct?
If so you have all the right codes and in the correct order and with the correct modifiers. Sometimes Medicare denies benign excisions for cosmetic purposes. If this was not cosmetic but documentation can support that there was suspicion for malignancy yet the path says benign then use V71.1 as the first-listed dx with the 216.6 secondary and link both to the excision code. It should work fine.
 
so are you saying to code:
11402 v71.1 216.6
12032 59 216.6
17000 59 702.0
with this we should get paid for the 11402 also?
 
I do not think so although I did wonder why the excision code was smaller than the repair code since the excision is suppose to be the Excised diameter there should not be that much difference in size so then RVU value should have the 11402 at the higher RVU although I have not looked. They are more likely denying it due to dx which is why we always use the V71.1 when supported by the documentation.
 
Actually you are applying the modifier 59 incorrectly. CCI edits show that is should be coded like this:

17000 diag 702.0
11402-59 diag 216.6
12032 -59 diag. 216.6

I have never had a problem with coding it this way. Now Cigna is rejecting everything with a 59 on it but when you send the notes and show it is 2 different areas they pay.

Hope this helps.

Amber
 
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