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Mohs Surgery - fellow Coders

  1. #1
    Default Mohs Surgery - fellow Coders
    Medical Coding Books
    Good afternoon fellow Coders


    I have a question about MOHS surgery procedure listed below Medicare is denying lines 5 and 6 as duplicate to lines 3 and 4 the report was sent and still denied I figure Medicare is denying due to the anatomical location below is a copy of the report any suggestions?

    1.17313
    2.17314
    3.17313-59( left anterior lower extremity, superior)
    4.17314x2-59
    5.17313-59( left anterior lower extremity, inferior)
    6.17314x2-59

    Thank you,
    TH

  2. Default
    Im pretty sure that you have to bill the 17314 in units and the 17313 needs a 76 modifier to let the insurance company know that it is same procedure different site.

  3. #3
    Default
    Thank you I will resubmit and see if that helps.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by LACEY13 View Post
    Im pretty sure that you have to bill the 17314 in units and the 17313 needs a 76 modifier to let the insurance company know that it is same procedure different site.
    you cannot use the 76 modifier since this is not a repeated service, a repeated service must be the same service repeated in a different session. also you should not bill the 17314 in units it should be listed separately with the 59 modifier. if the documentation clearly supports the different sites what was the rationale for denial on appeal? Is it possible to see the note?

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    I agree with Lacey13. In Washington state, Medicare requires billing in units.

  6. #6
    Default
    Thank you Lacey13 I had the claim resubmitted with the notes Im waiting to hear back.

  7. Default Mohs Denials as Duplicates
    In addition: Has anyone seen Medicare denying stages billed on separate lines as duplicates? We are in Palmetto GBA J1 Southern Cal. They were paying successfully like this. All of a sudden, Medicare is paying 17311, 17312 X3 Units, denying lines 3-5 (5th, 6th & 7th Stage) and paying the 6th line (8th stage) with the mod 76. When we called, they said Mod 76 is not appropriate, yet they paid a line item with the Mod 76.

    We were advised in 2009 by Inga Elzey Practice group to start billing multiple stages as follows:

    if pt has total of 8 stages:

    17311 1 unit
    17312 3 units
    17312 mod 76 1 unit
    17312 mod 76 1 unit
    17312 mod 76 1 unit
    17312 mod 76 1 unit

    Any feedback would be greatly appreciated.

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
    Default
    you do not use the 76 modifier you use the 59 modifier. The 76 is for a repeated service it is not repeated when you perform the service on a different area in the same session, it must be the same service same area different session to use the 76 modifier. The 76 bypasses discounting and that is not appropriate for multiple procedure in the same session.

    Debra A. Mitchell, MSPH, CPC-H

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