# Claim denial Help!!



## codecrazy (Nov 5, 2009)

We sent a claim with:
40490 lip biopsy
11101 BX skin, sq tis
11100-51 Biopsy of skin
99202-25 Office visit

11100 and 11101 were denied as inclusive?

HPI: This patient presents for evaluation of a scaly, red papule ont he left nasal sidewall previously removed.  Unfortunately, the lesion recurred.  It was scraped away in 2001.  She alo has a dark spot on the right upper lip that has continued to enlarge over the last several years.

The rest of the office visit documentation is fine.

Procedure reads as: A diagnostic shave biopsy was done for the lesion on the left upper nasal sidewall.  A diagnostic 2-mm punch biopsy was done of a representative area of the lesion on the right upper lip.  The defect was closed with one 6-0 nylon cuticular stitch.  She tolerated the procedures fine.

Help, I am lost.


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## mitchellde (Nov 5, 2009)

I see only 2 biopsies in the report and yet you have coded for 3.  you will need a 59 modifier, so what I see is
40490
11100 59
plus your office visit with the 25


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## codecrazy (Nov 5, 2009)

*I see....*

So it's not inclusive to 11100 it's inclusive to 40490.  Thank you for your help.


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## vikas.maheshwari (Nov 10, 2009)

I think 11100 and 11101 is the correct choice for the following service. 

99202-25
11100
11101
are the best choice


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## mitchellde (Nov 10, 2009)

I feel the 40490 is best for the lip bx as the physician specifies a bx of a piece of the lip lesion, the 40490 is a code specific for the lip area.


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