Multiple Claims in 1 Day

lnld9

New
Local Chapter Officer
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6
Location
Spokane, WA
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I'm taking over the Compliance portion for a small Dermatology Office. Right now the provider will submit MOHs on one claim, but then submit the biopsy on a different claim that gets signed off a week or more later. And another provider will chart and bill for the closures. This is causing multiple claims to be sent out for the same day, same provider, and it's causing denials usually for bundling. I know the provider needs to put the MOHs and the biopsy on the same claim as it's all the same day and same office, but I was wondering if there was some documentation as this has been the way they have been billing for years.
Thanks!
 
Messages
183
Location
Coeur d'Alene, Idaho
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I would recommend referencing the NCCI manual which can be accessed from this link:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
CPT also has a good description prefacing the Mohs codes. I would also recommend checking to see if your MAC has an LCD that discusses Mohs surgery. The LCD for Novitas can be found at this link:
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53883&ver=7&LCDId=34961&name=331*1&UpdatePeriod=830&bc=AAAAEAAAAAAA&
 

lnld9

New
Local Chapter Officer
Messages
6
Location
Spokane, WA
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I would recommend referencing the NCCI manual which can be accessed from this link:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
CPT also has a good description prefacing the Mohs codes. I would also recommend checking to see if your MAC has an LCD that discusses Mohs surgery. The LCD for Novitas can be found at this link:
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53883&ver=7&LCDId=34961&name=331*1&UpdatePeriod=830&bc=AAAAEAAAAAAA&
Thank you!
 

CatchTheWind

True Blue
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619
Location
Boca Raton, FL
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Which "biopsy" are you talking about? If you mean the examination of the tissue being removed during the Mohs procedure, this is not billable. It is part of the Mohs.

As for the Mohs and the closure by two different doctors, you can bill them on separate claims. Mohs and closure (regardless of type) don't bundle with each other, so there shouldn't be any problem. However, if one of the doctors does anything else at the same session (for example, a destruction), you will have to use modifier 59 rules based on all the procedures done by both doctors that day.
 
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My question goes back to the separate claims. If the Mohs surgeon performs the tumor removal via MMS in the office (location 11) , then the Physician assistant performs closure immediately following in our ambulatory surgery center (location 24) and bills directly under their own NPI to Medicare.....shouldn't the closure be subject to multiple procedure reduction rules?

Two claims are going out for two distinct providers, two NPI numbers, separate locations, but the same tax ID.

No modifier is going on the PA claim since there is not a bundling relationship to the MD's codes.

We cannot seem to locate this scenario in the claims processing manuals.
 

CatchTheWind

True Blue
Messages
619
Location
Boca Raton, FL
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If the payer requires modifier 51 when you have multiple surgeries, you should include that modifier. If they don't, their software should be able to catch this and reduce one of the payments. I don't think you have any responsibility to "alert" them, as long as you've used modifier 51 if they require it.

(Of course, most payers will mess this up and pay you the full amount for both, then come back many months later and ask for the difference back! I don't think there's any way to avoid this.)
 
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Sorry for the delay....thank you for your reply! Medicare specifically will "hard wire" the claim that contains multiple line items and instructs coders not to place the 51 on the claim as they will apply the modifier automatically.

We have been adding the 51 going out on the single line item claim all by it's lonesome...... and you are right......they still are not catching it!

We have tested another strategy by still appending the 51 but staggering the claims by a few days. Only then does their processing system catch it and reduce the closure by 50%. Hopefully this will reduce the refund nightmare sure to follow!

If anyone has an easier way (besides purchasing new practice software that will allow 2 locations on one claim) please share, it would be very much appreciated!
 
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