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Office visits not being paid same day as Mohs

debneas

Networker
Messages
36
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0
One of our Mohs surgeons performed Mohs and an ov same day. Then the doctor came back to the office at 9:30pm because the patient had excessive bleeding. Medicare is not paying either ov saying incidental.
This is what was coded:
17311 , 17312 with dx 173.31
99213 25 with dx 692.74
Then also a separate bill, same day
99213 78

What can we do to get both office visits paid?
 

mitchellde

True Blue
Messages
13,291
Location
Columbia, MO
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0
several issues here. First you cannot use the 78 modifier on an office level. Also you cannot charge more than one visit on the same day. why would the provider do an evaluation for solar dermatitis on the same day as the MOHS? If the basal cell ca was due to the solar exposure then you would not use the dermatitis code and the MOHS is a planned procedure so you should not have a separate complaint on that same day as a planned procedure.
As far as the visit for the excessive bleeding.. this is a surgical complication and needs a complication dx code, since a MOHS has no global you would be fine without a modifier however since it is on the same day as the procedure you may need to appeal to get it paid.
 
Last edited:

debneas

Networker
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36
Best answers
0
The MOHS and first ov were paid by medicare. The patient came in for MOHS then either the patient asked the doc to look at a spot or the doc found the solar elastosis. For the second ov 998.11 is a complication dx code so maybe my issue is what procedure/ov and/or modifier to code for the doctor coming back to the office at 9:30pm. Should we do a corrected claim and take out the ov with the mohs?
 

mitchellde

True Blue
Messages
13,291
Location
Columbia, MO
Best answers
0
you will need to roll both visits together and bill a corrected claim with only one level, remember any assessment related to the MOHS should not be counted toward the visit level.
 
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