September 5, 2019 Question: Our physicians have instructed us to bill under a physician’s NPI number for all Advanced Practitioners (PA’s and NPs) for all patients for Medicare as we follow incident-to billing. We have been submitting claims for all new and established patient visits regardless of whether there is a physician in the office....
August 22, 2019 Question: I’ve been dictating CPT and ICD-10-CM codes in my procedure note so that my coder knows what to bill. Recently, we had an insurance company call us out because the codes we billed were not the same as the codes in the procedure note. Now I am not sure what to do. What is...
August 8, 2019 Question: My physician performed Mohs surgery on a patient with a basal cell carcinoma on his cheek. He took the first stage with 6 tissue blocks, but does cancer is still evident in the margins based on the mappings. A second stage is removed with 4 tissue blocks. The second stage shows...
July 25, 2019 Question: I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the...
July 11, 2019 Question: Can we perform Mohs surgery without a pathology report? Answer: If you review CMS and other payor policies they all require a recent pathology report usually no more than 3 months old confirming the malignancy prior to performing Mohs surgery. *This response is based on the best information available as of...
June 20, 2019 Question: I destroyed 8 AKs and 3 SKs on a patient and also took a shave biopsy of another site. My codes are 17000, 17003 X 7, 17110, and 11102. Do I use modifier 51 or 59? I get confused on this issue. Answer: Since there are bundling edits for the codes...
June 6, 2019 Question: A pathology report came back from a skin biopsy stating “compound dysplastic lesion with severe atypia. Re-excision recommended.” Should the diagnosis code be D48.5 for lesion of uncertain behavior of the skin be assigned, or a benign code since it does not state it is malignant? Answer: Since the pathology notes...
May 23, 2019 Question: What is the correct code for a tangential biopsy of the antihelical fold? I was going to bill 11102, but I was told that there are different codes in other sections of CPT for some biopsies. Answer: The correct code would be 69100, Biopsy external ear. As a bonus, this correct...
May 9, 2019 Question: If I remove 3 small skin tags (less than 0.5cm) by shave technique from a patient’s neck, can I bill 11305 with three units due to the technique? Answer: No. According to CPT, the skin tag removal codes 11200-11201 are for removal of skin tags “by scissoring or any sharp method,...
April 25, 2019 Question: My doctor did two adjacent tissue transfers, one on the abdomen and one on the each leg of the patient. He wants to bill 14020 with modifier 50, but I don’t think that is correct. Help. Answer: CPT code 14020 has an indicator of “0” for bilateral procedures, which means that...
