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billing of multiple lipomas

  1. #1
    Location
    York, PA
    Posts
    60
    Default billing of multiple lipomas
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    We had a patient with multiple lipomas, requiring 8 separate incisions in different areas, ranging from the arm to the back to the abdomen. They were through 8 separate incisions, so I coded all that were of different sizes through different incisions, ending up with a lot of codes and a few repair codes (since repairs are added together if in the same area). Is there a limit to the number of excision codes/repair codes that can be submitted on one patient? Or is this a decision that would be made by the business office if they stop charging after a certain number of codes? The patient is upset at the total of the bill. Thanks for any help.

  2. #2
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    Quote Originally Posted by ms123 View Post
    We had a patient with multiple lipomas, requiring 8 separate incisions in different areas, ranging from the arm to the back to the abdomen. They were through 8 separate incisions, so I coded all that were of different sizes through different incisions, ending up with a lot of codes and a few repair codes (since repairs are added together if in the same area). Is there a limit to the number of excision codes/repair codes that can be submitted on one patient? Or is this a decision that would be made by the business office if they stop charging after a certain number of codes? The patient is upset at the total of the bill. Thanks for any help.
    I always code it as its dictated, so if they removed 8 lesions I agree with billing for the procedures. We use M's on the additional codes to reduce the RVU's that are paid to our providers and if a self pay we will give a discount on the subsequent codes. Did the patient require intermediate repair of the defects left by the excisions? I am just questioning why repair codes were billed. Also wondering if the patient was notified before the procedure that it may not be covered by insurance?
    Robin Plowman, LPN, CPC, CPMA, CEMC Analyst Manager ~Crazy Coder!! ~

  3. #3
    Location
    York, PA
    Posts
    60
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    Yes, repairs were intermediate on most, but not all. Only coded repairs for intermediates. Thank you so much.

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
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    Sorry the patient is up set.. however 8 were removed and that is what I would charge along with the intermediate repair. You should discount the second and subsewuent procedures for the self pay just as the insurabce will do since all were performed in the same setting.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    When we code the removal of lipomas we do not charge and additional code for the interm. closure due to the description in the Coder's desk reference stating "the incision is repaired with layers of sutures, staples or steri-strips." The code includes layer closure.

  6. #6
    Location
    Columbia, MO
    Posts
    12,570
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    A simple closure is included but an intermediate repair is always coded in addition to the excision.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    I agree with what you coded and all that ... but if the patient is self pay, did they not know of the cost prior to the procedure? or at least an estimated cost? If we have a self pay patient, they know of the cost, pay up front, sign their waivers and consents and the show goes on ... that way no one gets upset and everything is explained/answered prior to the procedure.

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