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Coding help

  • 1.  Coding help

    Posted 11-18-2017 10:23
    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!

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


  • 2.  RE: Coding help

    Posted 11-19-2017 06:01
    Hello. I think you are a great Dr. I think you did too much.
     I have learned to KISS. KEEP IT SUPER SIMPLE!!! I would have just done the pre-op and EKG. Chronic care for another visit and biopsy yet for another visit. I stopped using modifiers as long time ago. I have had a lot of rejections in the past. 





  • 3.  RE: Coding help

    Posted 11-19-2017 06:42
    hi,
    I believe it has to be modifier 59 which has to be used.





  • 4.  RE: Coding help

    Posted 11-20-2017 16:19
    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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  • 5.  RE: Coding help

    Posted 11-22-2017 08:26
    Micheal are you saying you take off a lesion and code 99214? Not the 114XX or 116 I think Xx codes?  So umm isnt that like then when   you know  "they" will not pay for a urine  drug screen you upcode to 9914  because you  had a suboxone visit that was a 99213 but you  did a udt ? Or upcode to 99214  if you include a INR test along with the suboxone  ( instead of whatever the heck the inr code is?) and their have a mitral valve prosthesis? Is this illegal? You are doing the same amount of work for al l these examples but of course 114Xx and 116 get you more dollars.

    COding needs to go!

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    Jean Antonucci
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  • 6.  RE: Coding help

    Posted 11-24-2017 17:38
    Jean,
    I believe i said i would code 99214 for the preop visit.
    At the next visit, I would code 99213-25 and 11100 for evaluation and management of the skin lesion and a biopsy.

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    Michael S. MD
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  • 7.  RE: Coding help

    Posted 12-15-2017 18:41
    Thank you, Rashmi!

    99214-25 (diagnosis E11.65, M48.061)
    11311       (diagnosis C44.319 basal cell)
    93000-59  (diagnosis R94.31)

    Paid total $217.93 with Medicare + supplement and all lines paid


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



  • 8.  RE: Coding help

    Posted 12-19-2017 16:24
    Hello all,

    Any issues with Tricare and vaccine reimbursement? Medicare primary, Tricare secondary for a Tdap I administered. The allowed charge was $32 for the vaccine (not administration)-about $17 less than what I paid for the vaccine.
    Thanks,

    Marie

    ------------------------------
    Marie Amina Aryan, NP-C
    FNP
    Lakewood Family Health Clinic
    303-578-8191
    Lakewood, Colorado
    Empathetic Family Healthcare clinic
    Lakewood CO
    303-981-1902Empathetic Family Healthcare clinicEmpathetic Family Healthcare clinicEmpathetic Family Healthcare clinic
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