Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Dermotology need help

  1. #1
    Default Dermotology need help
    Medical Coding Books
    Can someone advise me? This is what my Dr. billed to Medicare :
    11402 216.6 rejected /bundled
    12032 59 216.6 paid
    17000 59 702.0 paid paid mulitple proc rule 50%

    any idea's on why 11402 would not pay

    Thanks

  2. Default
    It denied as bundle because cleaning or removal of foreign matter is part of 12032.

  3. Default
    The 11402 code requires a 59 modifier when sent with those codes. The dx 216.6 is benign, Medicare does not pay for procedures done with no medical necessity.

  4. #4
    Default
    makes sense

    Thanks

  5. #5
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Ok so you have an excision of an anomoly that path says is benign, correct? and you did an intermediate repair of this excision, correct? and then you did a destruction of a different anomoly, correct?
    If so you have all the right codes and in the correct order and with the correct modifiers. Sometimes Medicare denies benign excisions for cosmetic purposes. If this was not cosmetic but documentation can support that there was suspicion for malignancy yet the path says benign then use V71.1 as the first-listed dx with the 216.6 secondary and link both to the excision code. It should work fine.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    would you have coded
    12032 216.6
    11402 59 216.6
    17000 59 702.0

  7. #7
    Default
    so are you saying to code:
    11402 v71.1 216.6
    12032 59 216.6
    17000 59 702.0
    with this we should get paid for the 11402 also?

  8. #8
    Location
    Columbia, MO
    Posts
    12,843
    Default
    I do not think so although I did wonder why the excision code was smaller than the repair code since the excision is suppose to be the Excised diameter there should not be that much difference in size so then RVU value should have the 11402 at the higher RVU although I have not looked. They are more likely denying it due to dx which is why we always use the V71.1 when supported by the documentation.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Quote Originally Posted by maynard1 View Post
    so are you saying to code:
    11402 v71.1 216.6
    12032 59 216.6
    17000 59 702.0
    with this we should get paid for the 11402 also?
    Yes that is what I am saying

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    Charlottesville, Va
    Posts
    7
    Default
    Actually you are applying the modifier 59 incorrectly. CCI edits show that is should be coded like this:

    17000 diag 702.0
    11402-59 diag 216.6
    12032 -59 diag. 216.6

    I have never had a problem with coding it this way. Now Cigna is rejecting everything with a 59 on it but when you send the notes and show it is 2 different areas they pay.

    Hope this helps.

    Amber

Page 1 of 2 12 LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.