# 11100 and 10060



## MichelleBursavich (Nov 21, 2017)

Has anyone had trouble getting payment from the insurance when billing these two codes on the same claim?

Patient was a new patient and during the encounter had a skin lesion biopsied and a separate I&D of a cyst. CPTs billed were 99203 (25), 11100, 10060 - UMR paid 10060 and denied 11100 stating that it cannot be reported on the same day that a procedure was performed. Any ideas? To my knowledge it doesn’t require modifier 59 but I could be wrong and overlooking something.


----------



## ellzeycoding (Nov 21, 2017)

I know that UnitedHealthCare has their own unique bundling edit for this pair.  Other carriers may too.

Add modifier 59 to the 11100.

Yes, this is outside the regular NCCI edits.


----------



## MichelleBursavich (Nov 22, 2017)

*Thank you*



ellzeycoding said:


> I know that UnitedHealthCare has their own unique bundling edit for this pair.  Other carriers may too.
> 
> Add modifier 59 to the 11100.
> 
> ...




Thank you, Mr. Ellzey! I utilized DermCoder here in my office as my current CDC certification is through Inga Ellzey Institute. I must have missed that disclaimer when plugging in those 2 codes. I will correct the claim adding modifier 59 to see if that gets the code paid properly.


----------

