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...
April 7, 2022 Question: One of our dermatologists saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The patient did...
March 24, 2022 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate? Answer: No, sorry, unfortunately it does not work that way. The problems are no additive or cumulative. One stable chronic illness and one acute uncomplicated...
March 10, 2022 Question: I heard that Medicare patients don’t have to pay their deductible or coinsurance if they have a telemedicine visit. Is this true? Answer: Medicare is not waiving deductibles or co-insurance. However, they are allowing providers to do so at their discretion without penalty for telemedicine visits. This means the provider will...
February 24, 2022 Question: We are using the 2021 E/M guidelines in the office and in most cases base the level of service on medical decision making. If I have a patient with a chronic condition that is stable who also has diabetes in which the Internist (nor our specialty) is managing, can I assume...
