CalDerm Alert
Recent Medicare - Palmetto Billing Issues

October 23, 2008

The transition from NHIC to Palmetto Medicare fiscal intermediaries has brought about a variety of challenges, including difficulty in accessing humans to speak to at Palmetto and non-payment for services that were previously covered by NHIC.

Palmetto has been strictly enforcing new and/or modified Local Coverage Determinations (LCD’s) and the National Correct Coding Initiative (NCCI) edits.  Non-payments for previously covered services are usually the result of an LCD or NCCI issue.  Consequently, billing and physician staff should familiarize themselves with the wording of the LCD’s and the NCCI.

Simple hints for effective billing:

  • Read and print out the LCD’s.
  • Use the approved CPT and ICD-9 billing codes for your services, including a primary and a secondary diagnosis code, when needed (particularly pertinent for the removal of benign skin lesions).
  • When two or more procedures are done on the same day, a modifier, usually .59, should be applied to the proper codes.  Code pairs are listed in the NCCI edits.  Simple version:  code in column 1 does not need a modifier;  code in column 2 needs the modifier.  Note that claims may also be rejected for attaching a modifier where none is needed.

Helpful Web Sites & Phone Numbers

Palmetto Codes for LCDs

AK – L28232

MOHS – L28278

Skin Lesion Non-Malignant Removal – L28300

Treatment of Ulcers and Symptomatic Hyperkeratoses – L28308

Treatment of Varicose Veins of the Lower Extremities – L28309

Application of Bioengineered Skin Substitutes: Ulcers (of Lower Extremities), J1B-08-0009-L (revised LCD)

Skin Lesion (Non Melanoma) Removal (formerly Non-malignant Skin Lesion Removal), J1B-08-0072-L (revised LCD)

Click here for More Information from the American Academy of Dermatology 


CalDerm Alerts - Archive


Legislative Alert
- June 2, 2008

NPI:  Use It Now!
 - February 28, 2008

Anatomic Pathology Services
Signed into Law Effective January 1, 2008
 - November, 7, 2007