CalDerm Alert
Recent Medicare - Palmetto Billing Issues
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
- PalmettoGBA
- PalmettoGBA E-mail Updates: You Can’t Afford to Miss Them
- PalmettoGBA / telephone number contacts listing
- Palmetto LCD’s Pertinent to Dermatology
- National Correct Coding Initiative (NCCI)
- California Medical Association
- American Academy of Dermatology’s Coding Specialists:
Peggy Eiden 847/240-1799 or Cindy Bracy 847/240-1840. (Use these when other sources of information have not helped).
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