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Family Practice Coding Alert

Reader Questions:

Reject Additional Lesion Denials

Question: I reported 17000 and 17003 to Medicare, which paid for 17000 but rejected 17003. The rejection reason states, "Payment adjusted because this procedure/service is not paid separately." I did not use any modifiers. Any suggestions?

Florida Subscriber Answer: You should appeal Medicare's decision.
 
Code +17003 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; second through 14 lesions, each [list separately in addition to code for first lesion]) is an add-on code for destruction of two to 14 lesions.
 
You report 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) for the first lesion that the family physician destroys and 17003 for each additional lesion - up to 14 - he destroys.
 
No modifier is necessary.
 
With the appeal, you should include documentation explaining that CPT permits 17000 and 17003. Send a copy of CPT's instructions following 17003 that state, "Use 17003 in conjunction with 17000."
 
Example: An FP destroys seven actinic keratoses. You would report the following:
 
CPT codes:    17000 (for first lesion)
      17003 with 6 units.
 

ICD-9 code:   702.0.


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