tci Outpatient Facility Coding Alert - 2013 Issue 4

Reader Question: Question Medicare for 17003 Claims

Question: We recently reported codes 17000 and 17003 to Medicare for reimbursement. Though the dermatologist destroyed multiple lesions, we only received payment from Medicare for 17000. Medicare rejected our claim for 17003. The rejection reason states, “Payment adjusted because this procedure/service is not paid separately.” We did not use any modifiers. Florida Subscriber Answer: Codes 17000 and 17003 are reimbursable in both the freestanding and hospital-based ASC settings with appropriate documentation so you should appeal Medicare’s decision. With the appeal, you should include documentation explaining that CPT® permits 17000 (Destruction [e.g., laser surgery, electrosurgery...

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