# Denial of multiple units of lesion excision (same CPT)



## lwcarter (May 25, 2016)

We've recently started to see denials for excisions (same CPT) on the same claim.  For example, 11403 x 3 units.  
Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
We've tried XS and 59 and neither of these modifiers get the claims paid currently.  
I've researched on CMS and am not finding a new policy.  
Any insight on a modifier that will work?

Thank you.


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## JesseL (Jun 1, 2016)

lwcarter said:


> We've recently started to see denials for excisions (same CPT) on the same claim.  For example, 11403 x 3 units.
> Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
> We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
> We've tried XS and 59 and neither of these modifiers get the claims paid currently.
> ...



You do not use units when billing the same excision codes.. at least I've never done it that way.

You bill it as such:

11403 1 unit
11403-59 or XS 1 unit
11403-59 or XS 1 unit

I don't think the modifiers are necessary since there's no NCCI conflict but I use them on the safe side..  I never used the new modifiers actually.


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## mdeanne (Jun 2, 2016)

*MUEs may be in play here*



lwcarter said:


> We've recently started to see denials for excisions (same CPT) on the same claim.  For example, 11403 x 3 units.
> Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
> We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
> We've tried XS and 59 and neither of these modifiers get the claims paid currently.
> ...



Hello-I looked up the CPT code 11403.  It has 2 for MUE.  So, theoretically 11403 1 unit,  11403-76 (or XS depending on your MAC), and 11403-76 would be billed and the third would deny.  With Medicare you would have to send in a redetermination showing your provider did perform this many units.  
Hope that helps.
MDeanne, CPC-D


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