Wiki Mulipule Excision- Malignant lesions

[midnight1995]

I need some help with the attached op note - this is what the provider billed
11606
11602 - 59
11602 - 59
11603 - 59
11602-59
11602-59
11602-59
11602-59
11606-59
11602-59
11602-59
11602-59
11602-59

 

[ellzeycoding]

OMG. THis poor patient.

20x20cm? that's almost 8 inches across. And all left open until path comes back.

This is one of the cases that will have to be sent in with notes showing medical necessity for manual review. Since it is metastatic melanoma, it should get paid. It may take a few attempts.

Now onto the coding issues

1. The Medically Unlikely Edits (MUEs) are as follows

11606 - MUE = 2
11603 - MUE = 2
11602 - MUE = 3

2. First, I'd place in descending order. Not all will need modifiers. Only the second and subsequent of each procedure type needs a modifier (depending on carrier preference)

3. Next, modifier 59 (XS) may not be appropriate depending on carrier. Some carriers like Noridian only accept 59(XS) for code pairs bundled under the NCCI edits. Many carriers will accept modifier 76 instead.

Some won't accept 59 (XS) or 76 and instead you have to add a note in Box 19 to override the MUE Edit. For example: On 03/15/2018, a total of 10 CPT 11602 performed

4. I'd reorder like this...

11606
11606-59 (or XS or 76)
11603
11602
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)
11602-59 (or XS or 76)

Good luck. This is a very unusual claim and circumstance.