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   RE: Coding help
 From: Michael Safran
 To: Member Forum
 Posted: 11-20-2017 19:19
 Message: Mamatha,

I would echo Dr. Cruz.   Your reward will come in the next life but not from insurance company.

I do not do biopsies or treatment of suspicious lesions when patient is seen for chronic care, or preop, or annual physical, etc.
I offer biopsy or cryo next week.    Most choose to return.   It is not just the billing / reimbursement, but the time needed.

I would have billed 99214 plus EKG for preop visit.    When they return for skin lesion, I usually code 99213-25 plus procedure code.    Pretty much always reimbursed.   I dont feel guilty about the extra visit code.   There will be a telephone call to inform pt of results, discuss treatment or referral, etc.







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Michael S. MD
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Original Message:
Sent: 11-19-2017 09:42
From: Rashmi Chhabra
Subject: Coding help

hi,
I believe it has to be modifier 59 which has to be used.



Original Message------

This Medicare claim keeps getting rejected.
I did a visit, pre-op EKG and a biopsy on the face which turned out to be basal cell on the pathology.

The visit is 99214-25 (E11.65 uncontrolled diabetes, M48.061 lumbar spinal stenosis)
11311 (procedure on face and coded as C44.319 basal call on face) I tried this without modifier 51 and then added modifier 51.
93000 EKG (tried coding as pre-op exam, then as abnormal EKG)

Any thoughts? I don't mind just sacrificing the pre-op EKG. Does the mole have to be coded nevus uncertain nature?
Generally do they pay for EKGs that are just for pre-op for Medicare patients?

The rejection note said " PER CCI GUIDELINES PROCEDURE CODE 93000 HAS AN UNBUNDLE RELATIONSHIP WITH PROCEDURE CODE 11311 BILLED FOR THE SAME DATE OF SERVICE. REVIEW DOCUMENTATION TO DETERMINE IF A MODIFIER OVERRIDE IS APPROPRIATE."

THANKS!

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Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
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