Wiki Add on code denied

[tholcomb]

Good afternoon all,

Patient came in for office visit had 2 biopsies done 11100, and 11101 and destruction 17000 done insurance denying add on code for biopsy 11101 due to that cpt code 17000 included with 11101 see below.

99213-25
17000
11100-59
11101

TH

 

[FTessaBartels]

Did you have THREE separate lesions?

If you have THREE separate lesions, then you need to appeal with the procedure notes that clearly show this.

Secondly, If there ARE three separate lesions .... 11100 has a higher RVU value, so I would list that first. Your -59 modifier will go on 17000.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[LACEY13]

Cci

If you look at the new CCI it tells you that -59 are added to all add-on codes now

11101
17003

if the original procedure goes with a -59 now the add on has to too.

 

[LACEY13]

and you were corrected the modifier goes on the 11100

 

[BABS37]

I agree with Tessa and this one depends completely on what the documentation is. If the biopsy and destruction were done on the SAME site, then you can't bill for both. You can't unbundle it. You bill the code with the higher RVU in that case. If a biopsy is done on one site and destruction is done on a completely separate site, then you can bill it. ***Anyhow, you can try to use modifier 51 if your insurance carrier allows that along with the 59 modifier. Here's in example:

"Exercise caution when appending the two modifiers for Medicare claims on the same date of service. When a carrier requires the use of the -51 modifier it must be used on the service with lower Relative Value Units (RVUs) while the -59 is attached to the service in the second column of the two lists;
Comprehensive Table and Mutually Exclusive Table. Sometimes, the service in the second column may be the service with the higher RVU.
For example when billing 17000 and 11100, the -51 would be applied to the 17000 since the RVU for 17000 is less than 11100. For Medicare, you would bill 11100 with the -59 modifier and 17000 with the -51 modifier."

 

[tholcomb]

Thank you for the information that was very helpful.