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multiple procedures

  1. #1
    Default multiple procedures
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    Hello-
    I was hoping someone can help me with how to get this paid.. or is this truely a write-off. This claim was submitted for a Medicare pt, no ABN

    dx code 702.11, 782.9

    14000
    11100-59
    11101
    11101
    11101
    17110-59

    They paid on all line items, except the 14000.
    Any ideas would be appreciated. thanks!

  2. #2
    Location
    Columbia, MO
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    What was the adjacent tissue transfer for? Which is the bundled code, meaning is the 11100 bundled into the 14000, or the 14000 bundled into the 11100? I have no picture here of what took place.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    oopps..

    14000 was suppose to be typed as 11400 (benign excision)

  4. #4
    Location
    Columbia, MO
    Posts
    12,572
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    OK! makes more sense, now I am assuming then the biopsys were in totally different locations? Because if not you need to drop the biopsy code, also you know you must wait for the path report when coding an excision code and I see no benign dx code to link.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    the biopsies were in different locations than the excision.
    The path report on the excision came back as a SK

  6. #6
    Location
    Columbia, MO
    Posts
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    Ahh the picture is comming into focus! So you linked the 702.11 then to the 11400 and the other dx to all the other codes? There is still some blurry areas here, so If you have documentation of 6 completely separate procedures on 6 separate areas, you have the basis for a great appeal. But now you see what the payer is going thru, there are not enough dx codes to satify their curiosity that 6 separate things were done. And that is by no means your failure! That is simply and ICD-9 issue. ICD-10 CM cannot get here quick enough for me!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    yes. the note is documented to indicate they were all different lesions, in different locations. I think that the ICD-9 codes being the same adds a different element in there. I think I will just send off an appeal with the notes..

  8. Default
    If they are all seperate procedures there needs to be a 59 on the 11400 and the 11100 if the insurance company follows the cci edits. If it is medicare they will not pay for the 11400 with a 702.11. With no abn you must write of the balance.

  9. #9
    Location
    Columbia, MO
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    no Medicare will pay a benign excision with 702.11, I forgot to say that at the cancer center we always used the V71.1 dx first listed for this scenario and it was always a win. You just have to show that it was not for cosmetic purposes.

    Debra A. Mitchell, MSPH, CPC-H

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