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Wednesday Mar 27, 2019

Billing for multiple skin procedures: three steps

When you perform multiple skin procedures during the same patient visit, billing for these procedures may involve bundling or require modifiers. To optimize payment and avoid denials, follow three steps:

1. Check the total relative value units (RVUs) for each code to determine which one is valued highest, as this is the code you’ll need to report first. The Centers for Medicare & Medicaid Services (CMS) provides this information online(www.cms.gov).

2. Check the National Correct Coding Initiative (NCCI) edits page(go.cms.gov), and click on the procedure-to-procedure (PTP) coding edits to determine if certain combinations of codes are bundled or otherwise not allowed.

3. Report the highest-valued code first on the claim form without a modifier. If the second procedure is the same as the first or is bundled into the first based on NCCI edits, submit that code too, with modifier 59, “Distinct procedural service.” If the second procedure is not bundled into the first, use modifier 51, “Multiple procedures” (although Medicare contractors may not require modifier 51). Follow the same logic for any additional procedures.

Note that payment amounts may vary when multiple procedures are performed on the same calendar day. The highest valued procedure may be paid at 100 percent, and procedures two through five may be paid at 50 percent. Billing more than five procedures may trigger a manual review by the payer. Finally, remember to submit a wound repair code if allowed by Current Procedural Terminology.

Read the full FPM article: “Skin Deep: How to Properly Code for Biopsies and Lesion Removal.”

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Posted at 11:00PM Mar 27, 2019 by FPM Editors

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