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Limitations for CPT code 17263

Nancy Posted Wed 30th of June, 2010 19:22:08 PM

My provider did electrodesiccation and curettage x 5 lesions from the trunk. We billed 17262
17263
17263-5976
17263-5976
17263-5976
Medicare paid 17262 @ allowable, 17263-5976 @ allowable & 17263-5976 @ multiple surgery guidelines. Medicare denied two of the 17263 because they state it exceeds the limitations. First I thought if these were the only procedures done that day then there would not be a multiple surgery reduction and how do you know what the limitations are? Do you know where I might find this information? Thanks for your help as always.

SuperCoder Answered Thu 01st of July, 2010 08:13:42 AM

I didn't came across any limitations for these codes, neither these codes have any MUE (Medically Unlikely Edits). Rather, I can only suggest that refile this claim on paper with proper documentation where the medical record/progress note should indicate the removal of a malignant lesion with a corresponding pathology report or a clinical description consistent with a skin malignancy. The size and location of the lesion must be included in the documentation.

Lisa Answered Mon 18th of October, 2010 22:49:31 PM

I think it may because 76 modifier is used to indicate a repeat procedure to the same lesion, you are doing five separate lesions. I would use the 59 as you are doing or consider using 58 planned procedure. Usually medicare will only allow a destruction if you have a path sustained malignancy. Try again but remove the 76 modifiers. Hope this works.

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