Wiki Blue Cross Blue Shield of IL lesion removal denials due to bundled

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jchoiesq

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Hi, just wondering if anyone has been experiencing denials from Blue Cross when the claim includes a shave removal (eg. 11300) on one site and destruction of lesion using liquid nitrogen on another site (17000 or 17003) with two different diagnosis codes and a 59 modifier on the 17000/17003. We are seeing denials on the 11300. The same occurs when there's an excision of a benign lesion (11422) billed with 17000.

Has anyone been able to successfully appeal these? Any insight or advice on this would be greatly appreciated.
Thanks,
Jennifer
 
Have you tried using modifier XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure” instead of 59? We are hit and miss with our shave removals with other procedures. Usually are paid once we send in clinical notes clearly showing different procedure/site from any excisions and/or destructions. But it is a huge time waste on our side since it was coded correctly to begin. :mad:

Nicole
 
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