To maximize your reimbursement when performing multiple skin procedures in a single patient visit, ensure that your practice follows these three steps:
1. Check the total relative value units (RVUs) for each code (https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx) to determine which is valued highest.
2. Check the National Correct Coding Initiative (NCCI) edits (https://go.cms.gov/2yLPjKp) to determine whether the codes are normally considered bundled.
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,” to indicate that it involved a separate lesion. If the second procedure is not bundled into the first, use modifier 51, “Multiple procedures” (although Medicare contractors may not require modifier 51). Do the same for each additional procedure.
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%, and procedures two through five may be paid at 50%. Billing more than five procedures may trigger a manual review by the payer.
Finally, remember to submit a wound repair code if allowed by CPT and, if you addressed an issue in addition to the skin procedures (hypertension, for example), include the appropriate evaluation and management (E/M) office visit code with modifier 25, “Significant, separately identifiable evaluation and management service.” Most payers will pay for the E/M code, but some have additional edits for skin procedures, making it a challenge to get both the office visit and the skin procedures paid.
Read the full FPM article: “Skin Deep: How to Properly Code for Biopsies and Lesion Removal.”
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