Resubmit Denied MMS (Mohs Surgery) Claims: Flawed Claims Edit Reversed by Novitas Solutions
As discussed at the Mohs Committee meeting Saturday, March 5, in Washington, DC, and through the good work of the American College of Mohs Surgery (ACMS), Novitas Solutions, Inc. has removed their inappropriate claims edit and impacted ASDSA members are urged to resubmit any previously denied MMS claims with hospital outpatient department POS codes (19 and 22) for payment. Local Coverage Determination (LCD) for Mohs Micrographic Surgery (MMS) (L34961) and a new audit (518D) had denied claims submitted with a place of service (POS) code other than office (11) or ASC (24) on or after January 1, 2016. ACMS worked to provide Novitas with evidence that Mohs surgeons did in fact perform all components of MMS and that hospitals were not billing for these services.
Impacted physician offices are urged to seek clarification from their local Novitas jurisdiction contacts directly to see if electronic or written resubmission is preferred for smooth reprocessing of the previously denied claims. Make sure any denials being resubmitted indicate the reason (flawed claims edit).
Novitas Solutions, Inc. is the Medicare Administrative Contract (MAC) covering Jurisdiction L (Pennsylvania, New Jersey, Maryland, Delaware, and Washington, DC) and Jurisdiction H (Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, and Mississippi.)
We have been informed by CalDerm that the initial ICD-10 diagnosis coded claims for 17000 and 17110 destruction series codes submitted to our California Medicare Administrative Contractor, Noridian, for services provided in early October were denied as not covered due to a programming error. This error has been corrected by Noridian. All subsequent claims should be getting processed correctly. Noridian should by now have automatically reprocessed, adjudicated and appropriately paid the claims. However, the adjusted claims have not and will not be automatically crossed over to the secondary insurers by Noridian. In order to receive payment from the secondary insurers you must identify the non-crossed over claims and manually bill the individual insurers.
Additionally, note that all of the 17000/17110 destruction code series bills that were originally rejected have been reprocessed except for all bills that had any type of additional service billed as same date of service as the destruction. In these cases, the other services (E/M, biopsy, for example) were adjucated properly, but the 17000/17110 series codes claims should soon be completed. Keep in mind that once these claims are properly paid by Noridian, it will still be up to your individual billing offices to forward them to the secondary insurers.
While we may all laugh at some of the new ICD-10 codes (V91.07 – “burn due to water skis on fire”; V97.33 – “sucked into a jet engine”), denial of legitimate claims is no laughing matter. As we anticipated, when literally thousands of ICD-9 codes were replaced by ICD-10 codes, occasional clerical errors occurred. In Florida, we immediately noted that our local coverage determination (LCD) governing the destruction of malignant lesions did not cover basal or squamous cell carcinoma (C44.xx and C44.xxx). When notified, our Medicare carrier (First Coast Service Options) promptly corrected this situation and made the adjustment retroactive to Oct. 1. Since then, however, other problems have been noted. The following adjustments/modifications to the LCD’s covering the excision and destruction of malignant lesions have been sent to First Coast:
LCD L33818 (Excision of Malignant Lesions)
ICD-10 code D04.5
(carcinoma in situ of trunk) needs to be removed from Group 2 codes (malignant
lesions of the scalp, neck, hands, feet, and genitalia) and appropriately
placed under Group 1 codes (malignant lesions of the trunk, arms, and legs). We
are presently receiving denials when we remove a carcinoma in situ from the
trunk, arms, or legs and code with Group 1 CPT codes (trunk, arms, legs)
because D04.5 is incorrectly listed under Group 2 (scalp, neck, hands, feet,
2. The ICD-10 codes for Merkel cell carcinoma (C4A.x and C4A.xx) and those for melanoma in situ (D03.x and D03.xx) need to be added to LCD L33818 under the Group 1 (trunk, arms, legs), Group 2 (scalp, neck, hands, feet, genitalia), and Group 3 (face, ears, eyelids, nose, lips).
3. ICD-10 codes C44.80-C44.89 should also be under Group 1 and Group 2 as well as Group 3.
LCD L33813 (Destruction of Malignant Lesions)
The ICD-10 codes for Merkel cell carcinoma (C4A.x and C4A.xx) and those for melanoma, in situ (D03.x and D03.xx) need to be added. I have worked closely with Peggy Eiden (AAD staff) to assure that those situations which have been requested by our colleagues or those which may reasonably arise, even if infrequently or rarely, are covered by the relevant LCD. As we become aware of other coding/reimbursement problems, they will be brought to the attention of our carrier so that they can be addressed.
I wish you all happy holidays!
Cliff Lober, MD, JD
ASDSA Liaison to the AAD Mohs Committee
P.S. If you have a patient with a “burn due to water skis on fire” or who actually survives being “sucked into [a] jet engine” please let me know.
Addendum: Since submitting the above, we learned that on November 19 First Coast Service Options, Inc., revised LCD 33818 (Excision of Malignant Lesions) to cover melanoma, in situ (D03.x and D03.xx) and changed the location of D04.5 (carcinoma in situ of trunk) from Group 2 CPT codes (malignant lesions of scalp, neck, hands, feet, and genitalia) to Group 1 CPT codes (malignant lesions of the trunk, arms and legs). These revisions are effective retroactively to October 1, 2015. I will be checking with First Coast to determine the status of our other recommended modifications to LCD L33818 as well as those applicable to LCD L33813 and appropriately pursue those recommendations