May 11, 2023 Question: Can we bill for a simple repair when the surgeon performs Mohs? Answer: An intermediate or complex repair, flaps or grafts may be reported in addition to MMS. The simple repair is included in the procedure and is NOT reported. *This response is based on the best information available as of...
April 13, 2023 Question: We are having difficulty determining what needs to be documented in the Mohs procedure not to make sure we are compliant with our documentation. Answer: The procedure note for Mohs Surgery should always contain Indication for procedure Biopsy results Location of lesion Number of lesion(s) Size of the lesion(s), Number of...
March 16, 2023 Question: What is the correct CPT code or CPT code range for skin screening exam for lesions suspicious of skin cancer? Answer: It would NOT be appropriate for a dermatologist to report a code from the Preventive Medicine range (CPT 99381-99397) because a dermatologist is a specialist. If a patient comes in...
February 16, 2023 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT : Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term...
January 19, 2023 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
December 15, 2022 Question: In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing. Answer: Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...
November 17, 2022 Question: I work with Dermatologists. I have taken a couple of your online webinars. I have a question regarding a denial of office visit 99214, I hope you can answer. The denial indicates that medical records do not support the level of service. In that type of situation, can we rebill the...
October 20, 2022 Question: My provider excised an epidermal cyst on the patient’s neck with a defect of 1.2cm. She also reported that she did an intermediate layered closure of the same size. I reported codes 11422 for the excision and 12041 for the suture repair. A modifier 59 was appended to code 12041 but...
September 22, 2022 Question: When billing 4 units of 11620 (4 charges with 1unit a piece with 76 modifier) to a Medicare Advantage plans we are getting denied for MUE stating that 3 units can only be reimbursed on the same date. Will changing the modifier to 59 bypass this edit or is it Medicare’s...
August 25, 2022 Question: When billing a foreign body removal code of 10120, the surgeon incises the finger and looks around for 25 mins and no foreign body is found, do we bill a 52 since no FB was found or do we bill the 10120 without the modifier since the provider did perform the...
