Wiki Multiple 11606 Denial

[lisa.gullo]

I'm hoping some of you can help me out.

My surgeon recently performed several malignant lesion excisions (11606) on the same patient but in different locations (both arms and a leg). It came back as denied because MCR said it could only be billed 2x per day and the pt had 4 lesions removed. I coded it as:
11606-RT
DX: 173.62

11606-XS, RT
DX: 173.62

11606-XS, LT
DX: 173.62

11606-XS, LT
DX: 173.72

Has anyone had an issue like this before? In Select Coder, the MUE is 2 so are you only allowed to bill 2 per day? Especially the malignant lesions, it would make sense that the dr would be able to charge for all of the removals.
Any help would be greatly appreciated! Thanks!

 

[mitchellde]

First you do. To use Rt and Lt with the skin excision codes. The next question I have is we're all the excisions really the same size? Do you have a path report showing the malignant pathology? I was unaware that the MUE was 2 for this code but if you check everything and they truely were all the same size and you have the path report, then I feel an appeal in definitely needed.

 

[lisa.gullo]

The path shows "Invasive squamous carcinoma" for all of the excisions.

The sizes of the excisions were:
Right forearm: 1.5 x 4.5cm
Right forearm: 5 x 15cm
Left forearm: 5 x 15cm
Left thigh: 7 x 20cm

 

[mitchellde]

Those are some huge lesions from the sizes. I think you will need to appeal this one and hopefully you have an excellent procedure note for the excisions. Be sure to submit the path report as well which affirm that each was a separate specimen. I wish I had better advice or magic but I don't.