Forum - Questions & Answers

Apr 15th, 2014 - Hev7970

Adjacent Tissue Transfer billing to WPS Medicare Carrier

Can anyone shed light on how the Medicare carrier WPS(Wisconsin Physicians Service) want ATT's billed when multiple flaps are performed the same day/same session. An example is below:

Pre-Auricular Skin Cancer - Primary Defect 6.5 x 2.0cm, Secondary Defect 12 x 4 cm (total 61 sq cm)

Left Facial Skin lesion - Primary Defect 4.1 x 2.0 cm, Secondary Defect 8.2 x 4.0 cm (total 41 sq cm)

Normally, we would bill this as 14301, 14301-59 and 14302. But, WPS has information on their web-site that they consider it inappropriate to use 59 to indicate that the exact same procedure code was performed twice on the same day and will deny(as they did initially with this claim indicating invalid/inconsistent modifier) When asked, they referred us to the "Michigan Quantity Bill Listing" that indicates codes that allow more than "1" unit to be billed. According to this list, CPT® 14301 has a "999" in the "Multiple Service" column under TOS "2", which I am assuming means WPS considers no limit on how many units can be billed as quantity and require it to be billed on a single line with multiple units. Therefore, we should bill the above claim as 14301 x 2 units and 14302 x 1 unit. However, when we billed like this, 14301 was then denied due to "medical necessity". On Appeal, WPS said that "Medicare regulates number of services for 14301 to one per day". So, now what. We have billed it both ways with no success and submitted the operative report with the redetermination request. Cannot get any answers from WPS on this issue. Is our only option to go to the next level of appeal? I just want to make sure I am understanding everything and billing correctly before I push it to the next level. We have several claims denied for the exact same reason and have submitted re-determination requests for these also, but have yet to hear their decision on these. Many Thanks



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association