Otolaryngology Coding Alert
Claim With 12051 and 11442 Should Be Allowed
Question: Humana denied our claim listing 12051 with 11442. We’re not sure what the problem is. Do you have any insight?
Maine Subscriber
Answer: Correct Coding Initiative (CCI) edits do not bundle 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) and 11442 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm). That means the codes should normally be payable together, but not every payer follows CCI edits. Contact your insurance representative to discuss the claim and learn if the denial was a mistake on their part or if you need to include additional documentation to meet Humana’s guidelines. If necessary, contact your state’s Department of Insurance and Medical Society to further appeal this incorrect bundling of two services which are not only not considered bundled by NCCI but are not considered inclusive in AMA instructions.
Otolaryngology Coding Alert
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