“I have a simple question for which I have not been able to find the correct answer. I have a Medicare patient whom we took to the operating room to remove 3 skin lesions. Two were removed from the left foot and one was removed from the right foot. We used code CPT 11421 and are planning on billing the following way:
CPT 11421 – 50 (2 units, one lesion on the LT and one the RT)
CPT 11421 – LT (the other lesion on the LT)
I checked CCI edits and it says I do not need to use a 59 modifier but I feel like I should. Some people have said to use XS modifier. Some have said to bill one code 3 units and others to bill 11421 3 times. What’s the correct answer?”
by Tahlia Brody, CHP, VP of Customer Service TLD Systems
July 12, 2022
By tahlia@tldsystems.com
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Investigations and audits are being triggered by patient complaints. One such complaint that was investigated by OCR cost the office $28,000 and were found to be violating several HIPAA regulations.
“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”
