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use 51 or 59 on third procedure?

  1. Default use 51 or 59 on third procedure?
    Exam Training Packages
    For a general surgeon.... Billing removal of 3 scalp masses. Which modifier/modifiers would be correct?
    11422 - for the first one
    11422-51 - for the second one
    11422-51,59 for the third one

    Thanks for your help!

  2. #2
    Location
    Columbia, MO
    Posts
    12,560
    Default
    If you want them to be recognized for separate payment
    11422
    11422 59 51
    11422 59 51

    The 51 modifier is used to indicate procedures performed in the same setting for discounting purposes, the 59 is the modifier that identifies each procedure as distinct and separate. You always put first the modifier that adjusts the reimbursement the most, the 59 says "pay me" the 51 says "reduce me"

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Great! Thanks, Debra!!

  4. #4
    Location
    Springfield, IL
    Posts
    3
    Smile Skin lesions
    You could also code the procedure as the total of all three and include the 22 indicating unusual or complicated excision

  5. #5
    Location
    Evansville Indiana
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    451
    Default reply
    According to CPT guidelines you should not add the lesions together. "Report separately each benign lesion excised." The closures need to be added together (if they are able to be billed) not the excisions.

  6. Default
    Billing a quantity of 3 for CPT 11422 does not mean that the total sum of area is being added together. If that were the case, then a different code would be needed to make it larger by adding the sum of the three lesions together.

    Having said that, one can't add the sum of the lesions, but CPT 11422 IS allowed to be quantity billed. Then no modifier is necessary for the multiple services.

    I don't know about adding modifier 22, is there a reason that would be necessary?

    Kris

  7. #7
    Location
    Columbia, MO
    Posts
    12,560
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    Actually the code is not allowed to be quantity billed. As it is not a quantity code it is a unique code for each independent excision. You should never bill surgical procedure with units you should always list each one and use the modifiers. I know others will disagree they always have and always will.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default
    From my experience what Debra had suggested is the most accurate way of billing the scenario.

  9. Default
    I do hear what you are saying about the quantity. Perhaps some carriers may not allow it. WPS Medicare Part B, for Michigan, does allow it to be quantity billed, as well as for Illinois, Minnesota and Wisconsin. Here is the website with that information:

    http://www.wpsmedicare.com/part_b/bu...tybilled.shtml

    What is confusing sometimes may be terminology. In using the words of billing excised lesions "separately" (versus adding lengths together) or billing sizes that fall into the same lesion excision code with a "quantity". Billing a quantity does not indicate that we have added the lesion sizes together, but that there were three lesions of similar size and in the same body area.

    Having said all of that, this is JMHO. Perhaps check with the carrier you are billing and see if they will accept it with a quantity. The worse they could say is no.

    Kris

  10. #10
    Location
    Columbia, MO
    Posts
    12,560
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    Actually per the link you provided: In the Medicare manual it states:
    Item 24G - Enter the number of days or units. This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume. If only one service is performed, the numeral 1 must be entered.
    Some services require that the actual number or quantity billed be clearly indicated on the claim form (e.g., multiple ostomy or urinary supplies, medication dosages, or allergy testing procedures). When multiple services are provided, enter the actual number provided.
    For anesthesia, show the elapsed time (minutes) in item 24g. Convert hours into minutes and enter the total minutes required for this procedure.

    Each individual procedure is actually a different service not a multiple of the same service. Kind of a hard concept but it is true. The MUE are the number of times per day Medicare will allow the same service to be billed. At any rate I know this will not stop the usage of units, but if you compare claims (I Have) you may see that individual listing of services actual increases reimbursement. Maybe not with every carrier but enough to make a difference.

    Debra A. Mitchell, MSPH, CPC-H

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