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Coding

Latundra Posted Mon 13th of April, 2020 16:31:09 PM
Patient seen in office. I billed 11400-25, 17000 and 17003 to Wellcare Medicare Advantage Plan, but was denied: 11400-25 (issue with modifier), 17000 (not billed separately or billed by itself) and 17003 (add on code cannot be billed by itself). I'm confused. What did I do wrong?????
SuperCoder Answered Tue 14th of April, 2020 09:43:39 AM

Hi,

Thanks for your question.

As per the NCCI edits, Code 17000 is a column 2 code for 11400, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. The two codes are mutually exclusive procedures.

Since, we have limited documentation. Therefore, if the excision and destruction treat separate lesions, you may report both procedures. CCI bundles 11400 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less) into 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion.

The edit indicates a modifier is allowed to override the edit when circumstances are appropriate. Modifier 59's definition indicates, "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury [or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual."

The billing might have denied, due to modifier issue.

Thanks.

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