Multiple Procedure Designation Changed for CPT codes 17311 and 17311 on Same Day

Medicare announced corrections to the 2007 fee schedule effective April 1, 2007. The Multiple Procedure Payment formula for CPT code 17311 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks and CPT code 17313 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks has been corrected from a status indicator 2, standard multiple procedure payment formula reduction being applied when both services are reported on the same day to a status indicator of 0, No payment adjustment rules for multiple procedures apply. If the medical procedure is reported on the same day as another procedure payment is based on the lower of actual charges or fee schedule amount.

Action Steps:

1. If possible, change the indicators in the practice management system to always expect 100% reimbursement on these procedures.

2. Educate payment posting and accounts receivable staff to monitor payments closely for accurate payment.

3. Appeal any low pays where the multiple procedure payment formula is inappropriately applied.

4. Review 2007 payments to date and appeal low pays due to error in multiple procedure designation.