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11046 Add-on, Medicare Limit?

  1. #1
    Default 11046 Add-on, Medicare Limit?
    Medical Coding Books
    My doc performed a large debridement on a patient into the muscle/fascia. The area was over 600 sq cm. I billed Medicare using 11043 and 11046 x34. They are denying this as they state "the number of units of service exceeds our acceptable maximum". I have in the past billed commercial insurances in this manner with no problem. I cannot find anywhere on their website what is the maximm units is that I can bill. Does anyone have any info or where I can find the needed info.

    Thanks!

    Lori

  2. #2
    Default
    I have had the same problem. I came to the conclusion that Medicare is only allowing up to 4 units on 11045. I searched the entire Medicare site and only found out that these codes appear as a MUE, Medically Unlikely Edit. I sent redetermination requests on all the ones they denied. I just got another Medicare EOB and they upheld the original denial. My next step is to request a second level appeal.

    Susie

  3. #3
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    I was just about to send in my second level appeal when I got in the mail several letters from Medicare in response to my redetermination requests. They ruled fully favorable on a few, partially favorable on one and not favorable on one. I may need to request a second level appeal on the ones they ruled not favorable. It sure is a lot of paperwork for just a few extra dollars in reimbursement. Thats Medicare for you.

    Susie

  4. #4
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    Quote Originally Posted by RainyDaze View Post
    My doc performed a large debridement on a patient into the muscle/fascia. The area was over 600 sq cm. I billed Medicare using 11043 and 11046 x34. They are denying this as they state "the number of units of service exceeds our acceptable maximum". I have in the past billed commercial insurances in this manner with no problem. I cannot find anywhere on their website what is the maximm units is that I can bill. Does anyone have any info or where I can find the needed info.

    Thanks!

    Lori
    Surgical servicesshould not be billed with units greater than 1. Youneed to have a separate line item for each distinct 11046, so if you have 34 of them then ok you will have 34 lin3 items using the 59 modifier . But check your math first i think you are incorrect on the number of 11046 you have if the total is indeed 600 sq cm. Also be sure theprovider did document this as sq cm and not inches or mm.

    Debra A. Mitchell, MSPH, CPC-H

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