Wiki insurances not updated with the new biopsy codes

[JesseL]

So almost all insurance companies except for MEDICARE seems to not have updated their systems to accept the new biopsy codes...

Do we continue to use 11100 and 11101 or wait it out?

 

[thomas7331]

I'd recommend waiting and let them correct their error and not add your own to the mix. If you submit incorrect codes just to get payment, you'll end up having those payment recovered somewhere down the road and then will have to submit corrected claims all over again. Two wrongs don't make a right, so to speak.

 

[robertn.meza]

Hello, Yes I am in agreement. Don’t revert to inactive skin biopsy CPT codes just to receive reimbursement for 2019 dates of service.We have a number of HMO’s that haven’t updated their online portals to allow us to request authorizations for the new skin biopsy CPT’s. Commercial insurance companies will have to conform to AMA CPT changes! Best of luck!
-Robert Meza

 

[JoannaRupert]

Biopsy for Rash

Has anyone seen the new LCD # 33445 for Removal of Benign and Malignant Skin Lesions? This is the latest LCD that they added the new biopsy codes to and on that LCD a rash (R21) no longer is allowed to be used as a diagnosis. My physicians use this as a last resort in treating a rash that will not respond to topical medication and if they knew what type of skin condition they would use that diagnosis. Has anyone been able to get this combination paid?

 

[ckerley]

We are just running into this as well. So glad to see I'm not alone with this! My office manager is doing some searching on the AAD website, crossing my fingers that will uncover some answers. If so I'll pass them along

Has anyone seen the new LCD # 33445 for Removal of Benign and Malignant Skin Lesions? This is the latest LCD that they added the new biopsy codes to and on that LCD a rash (R21) no longer is allowed to be used as a diagnosis. My physicians use this as a last resort in treating a rash that will not respond to topical medication and if they knew what type of skin condition they would use that diagnosis. Has anyone been able to get this combination paid?

 

[irishcos]

I am getting paid for the new biopsy codes but several of the insurance companies are denying 17000, 17003 and 17004 if they are billed on the same claim. Has anyone else had this issue?

 

[JesseL]

I am getting paid for the new biopsy codes but several of the insurance companies are denying 17000, 17003 and 17004 if they are billed on the same claim. Has anyone else had this issue?

You can bill 17000 for 1 lesion and 17003 for each additional lesion up to 14.

OR

You can bill 17004 for 15 or more lesions.

I don't know if you meant you're billing all three of those codes on one claim but it will get denied if you do.

 

[CatchTheWind]

You may want to delete this and re-post it as a separate thread.

Has anyone seen the new LCD # 33445 for Removal of Benign and Malignant Skin Lesions? This is the latest LCD that they added the new biopsy codes to and on that LCD a rash (R21) no longer is allowed to be used as a diagnosis. My physicians use this as a last resort in treating a rash that will not respond to topical medication and if they knew what type of skin condition they would use that diagnosis. Has anyone been able to get this combination paid?

 

[CatchTheWind]

They are being denied because the modifier rules have changed. 17000 now needs modifier 59 with biopsies (but 17004 does not). Check the CCI before coding anything with the new biopsy codes, as the rules for where the 59 modifier goes are all over the board!

 

[CodingKing]

They are being denied because the modifier rules have changed. 17000 now needs modifier 59 with biopsies (but 17004 does not). Check the CCI before coding anything with the new biopsy codes, as the rules for where the 59 modifier goes are all over the board!

They probably should have added NCCI edit for all lesion codes when billed on same day as a biopsy as supported by the NCCI manual. My guess in the case of the 15+ lesion code that it can automatically be assumed that biopsy was not done on all 15+ lesions

 

[Eshay]

New BX codes

We are having the same issue. Ins Co are paying for E&M and Primary Bx code and denying the add on Bx code. Not sure how to get around this. Example-- 99213-25, 17000- XS, 17003-XS, 11103, 11104. Whole claim denied. Derm Coder says to add mod 51? Any suggestions. I haven't seen any articles or any new info on adding mod 51.

Thank you
Erica