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...
July 28, 2022 Question: Can you please assist with the diagnosis for a Compound Dysplastic Nevi of back? Biopsy confirmed and not completely excused. Patient comes in for excision of lesion. What diagnosis code should I use? Answer: The correct diagnosis code for a dysplastic nevi of the trunk is D22.5 (melanocytic nevi of trunk)...
June 30, 2022 Question: I am new in Dermatology coding and am currently coding for a Mohs surgeon. I was instructed that if the patient comes in and does not have a confirmed malignancy based on a pathology report and the physician does a biopsy to confirm the malignancy prior to Mohs surgery we can...
June 2, 2022 Question: I am trying to code an I&D of a pilonidal cyst. CPT 10080 is simple and 10081 is complicated. How to do I know which code to choose? Answer: Great question, you would report CPT 10081 (complicated) if the procedure requires marsupialization, approximation of the wound’s edges, and/or primary closure. *This...
May 5, 2022 Question: When determining if an illness is chronic versus acute is it based on how long the patient has had the condition or is it based on if the condition is considered a chronic or acute condition? Answer: The AMA defines chronic as: A problem with an expected duration of at least...
