- While you are in your office an established Medicare-insured patient sees your PA. During the course of the routine follow-up visit you leave for the hospital to do an inpatient consultation, as you have full confidence in your PA’s expertise. You subsequently bill the visit as an incident-to service under your NPI.
- A patient comes to you for evaluation of a skin tumor treatment. He brings along a copy of a pathology report and the original slides for your review. You evaluate the patient and interpret the biopsy slide tissue. You bill 99203 for the initial patient visit along with 88321, “consultation and report on referred slides prepared elsewhere.”
- You destroy a cheek basal cell carcinoma via curetting and electrodesiccation to a 1.1 cm diameter. After evaluating the depth of curetting you decide that it would be best therapeutically and cosmetically to excise the site with margins and suture the defect linearly. The excised defect measured 1.5 cm in diameter. After consulting the NCCI table you bill 17282 for the destruction and 11642-59 for the excision and single layer closure.
- You excise a Medicare patient’s previously stable but now suddenly tender, red, and bulging epidermoid cyst located on the back. You bill for the excision along with ICD-9 diagnoses 706.2 for the cyst and 682.2 for the abscess.
- You have added a recent graduate from dermatology residency to your practice. While the new dermatologist’s Medicare enrollment is being processed you want to be paid for his/her services. So, you bill Medicare for the new physician’s services under your identifier as a locum tenens, with the Q6 modifier.
- In October 2015 you want to appeal a rejected claim for services rendered on Sept. 29, 2015. As ICD-10 is then being exclusively used, you consider whether ICD-10 diagnostic codes should be submitted on the appeal. However, since the billed services were in September of 2015, you appeal using the original billed ICD-9 coding.
In order to test Medicare’s ability to properly process ICD-10-coded claims, you decide to send in occasional real patient claims with ICD-10 diagnostic coding to your MAC prior to Oct. 1, 2015. You expect that if the claims are paid, you have coded properly.
As test billing in the ICD-10 format seems to constitute a burden to your office, you decide to avoid the hassles of test billing with ICD-10 codes prior to Oct. 1, and will simply confidently “go live” with the new code set on Oct. 1.
In order to ensure that your claims are appropriately processed after Oct. 1, 2015 you submit diagnosis lines to your Medicare Administrative Contractor with both ICD-9 and ICD-10 codes for the same diseases/conditions.
A patient comes in for an examination following an excision of a Merkel cell carcinoma six months ago. You do a complete skin examination, palpate nodal basins, and evaluate any pertinent laboratory results. As no new tumor is identified, you append a diagnosis code for “Personal history of other malignant neoplasm of skin” (not melanoma): Z85.828.
You biopsy and simultaneously destroy with curetting and electrodesiccation a lesion located on the left arm that you are certain is a basal cell carcinoma. You hold billing until the receipt of the pathology report. Whoa! The lesion is actually an amelanotic melanoma! You then apply ICD-10 code C43.62, malignant melanoma, left arm, and bill the insurer.
You excise a melanoma on the right chest. Your insurance biller submits a bill with ICD-10 diagnostic code C43.59. You are surprised at the coding, as you specified the right side and expected the last digit in the code to be a “1”, denoting a melanoma located on the right side of the patient. Was the billing done correctly?
A patient with diabetes mellitus presents with a bilateral pretibial eruption that you diagnose as necrobiosis lipoidica diabeticorum (NLD). Your biller selects ICD-10 code L92.1, necrobiosis lipoidica, and sends the bill to the insurer.