Wiki 11100 and 10060

[MichelleBursavich]

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]

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]

Thank you

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.

View attachment 3204

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.