• 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.

    2. Check the National Correct Coding Initiative (NCCI) edits page, 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.”

    Posted on Mar 27, 2019 by FPM Editors

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.