Skin Tags 11200 and Biopsy code 11100

LBernat7

Networker
Messages
65
Location
Wayne, PA
Best answers
0
Question

Notes state pt came in for 15 skin tags dr states they are cosmetic and collected 115 to treat as cosmetic. Pt signed ABN form stating that they want the insurance billed for this service 11200 and while they realize we may ask for payment up front they want insurance to make final decision. ALSO dr took one tag and sent to the lab for pathlogy for stating it was irritated and charged 11100. Notes very brief as follows:

15 skin tags-cosm

r axilla 1irritated tag-biopsy sent

HELP please
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
even though it was irritated and he sent it for pathology it was still a skin tag removal. I would charge only the 11200. A biopsy is when the provider removes only a portion of a suspicious lesion, in this case he still removed the entire skin tag just then same as all the others. I see no need of an additional charge as no additional work was performed by your provider. The pathology might be covered but that is a different provider.
 

ellzeycoding

Guest
Messages
392
Best answers
0
Several issues here.

Most carriers have benign lesion removal policies that cover 11200. 11200 is often a code that requires a second DX to show medical necessity (irritated, inflamed, painful, etc.)

For example, take this LCD... L91.8 for Skin tags is listed in Group 2, requiring a DX from Group 3 for coverage (medical necessity).

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34233

Billing 11200 (up to 15) with L91.8 alone should get them rejected if they were cosmetic and not irritated.

The issue has to do with the one that was irritated.

Several issues here...

1. 11100 and 11200 are bundled in the NCCI edits. You cannot biopsy (take a sample of a portion of) a lesion that you completely removed (11200/11201). I think you intended to mean that you removed it (that was the intent so use 11200/11201) and then sent it to path (88304)

2. The next question is why it was sent to path. If the provider new they were skin tags and one was irritated, path wasn't necessary.

3. You technically removed 16 skin tags. Ordinarily that would be 11200 x 1 unit for the first 15 and 11201 for the next nest 10....

However... the first 15 have only 1 diagnosis (L91.8). The second one has L91.8 and L59.3 (erethema/irritated) to show it was not cosmetic

Technically you bill

11200 L91.8
11201 L91.8 L53.9

HOWEVER, the first block of 15 will be denied as medically unnecessary. This should pass on to the patient. The next one "should" pay (around $19.50 average). The question will be if the carrier allows payment on the add-on code (11201) if the primary code (11200) is denied as not medically necessary

This might involve sending in a claim with notes and clearly stating that 15 were cosmetic (non-irritated) and only 1 was irritated.
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
was it a total of 15 with one sent to path? this is how I read it. or
was it 15 cosmetically removed and 1 additional sent to path? this how the other responder read it.
If there was in fact a total of 16 then I agree with the second post. If the were 15 total then I stand by my first response.
 

LBernat7

Networker
Messages
65
Location
Wayne, PA
Best answers
0
I do believe 15 were total not 16. As far as if notes indicated irritated. What additional code would you bill out (not maybe in this patient's case but another) if it was skin tags removed and notes state irritated. I cannot find a code for that in addition to skin tag code
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
there are many different opinions on what to use for irritated skin tags. some indicate the L91.8 covers the irritated skin tag. Some indicate L98.8 for other specifies skin disorder and others indicate the L53.8 for other erythematous condition.
I go with the L53.8.
 

ellzeycoding

Guest
Messages
392
Best answers
0
Yes, your question and wording is confusing and inconsistent...

You stated

"Notes very brief as follows:

15 skin tags-cosm

r axilla 1 irritated tag-biopsy sent"



To me this reads 15 skin tags that were cosmetic and 1 skin tag (located on right axilla) was irritated... since this was listed on a separate line...

or 16 total!

This is a great example of how poorly documented chart notes can be interpreted differently.


For the second diagnosis use the link to the LCD that I posted previously L91.8 is shown as a Group 2 code. By itself, usually isn't covered for most carriers.

Group 2 Paragraph: List II. These ICD-10-CM codes identify those conditions for which payment is allowed only if the conditions have complications, these being listed in List III below.

Note: Diagnoses from List II must be accompanied by one of the diagnoses from List III for payment to be allowed. List III gives justification (reasonable and necessary) for allowing payment.



Either of these these below can be used to show irritation... (shown in Group III)

L53.8 Other specified erythematous conditions
L53.9 Erythematous condition, unspecified
 
Last edited:

LBernat7

Networker
Messages
65
Location
Wayne, PA
Best answers
0
Yes, your question and wording is confusing and inconsistent...

You stated

"Notes very brief as follows:

15 skin tags-cosm

r axilla 1 irritated tag-biopsy sent"



To me this reads 15 skin tags that were cosmetic and 1 skin tag (located on right axilla) was irritated... since this was listed on a separate line...

or 16 total!

This is a great example of how poorly documented chart notes can be interpreted differently.


For the second diagnosis use the link to the LCD that I posted previously L91.8 is shown as a Group 2 code. By itself, usually isn't covered for most carriers.

Group 2 Paragraph: List II. These ICD-10-CM codes identify those conditions for which payment is allowed only if the conditions have complications, these being listed in List III below.

Note: Diagnoses from List II must be accompanied by one of the diagnoses from List III for payment to be allowed. List III gives justification (reasonable and necessary) for allowing payment.



Either of these these below can be used to show irritation... (shown in Group III)

L53.8 Other specified erythematous conditions
L53.9 Erythematous condition, unspecified
Thanks for your help the wording I gave you was exactly as how I was seeing it presented in chart notes. It was however after speaking to the dr that I was told it was 15 total. I posted before I was able to speak to the dr just to have something to go from.

In the past insurance has paid both the L91.8 and the L53.8 in that area of 11200 (we are in PA if that makes a difference) if the notes have been called for and the insurance has flagged te claim if the notes support that they were irritated usually they just go and pay the claim. The issue here was patient paid as a cosmetic patient for removal but the notes and billing by dr were for a 11100 and 11200 so it was very confusing from the start and obviously a concern.

I appreciate all the input thanks so very much honestly it was a help
 
Top