Wiki Claim Denial: Mutually Exclusive Procedures

[jenmendoza]

Hello, everyone!

I am not sure if this is posted yet. But I have a quick question regarding denials and appeals for California.
Recently, we have had a denial for mutually exclusive procedures: unbundling for the codes as follows:

17000 - L57.0 AKs
17003 - L57.0 AKs
17110 - B07.00 Plantar Wart, L82.0 Inflamed SKs

In this case, the insurance paid for 17110 and denied 17000 and 17003 for the aforementioned reasoned above. We sent an appeal with medical records explaining to them that the procedures were done for different reasons, under different diagnoses, however, the insurance company upheld their denial with the same reason. In regards to this, my question is:

1) Is there a better way for us to code this?
2) Is there a mediator or third party person we can reach out to to resolve the conflict between the insurance company and the providers regarding this?

Any comments or suggestions would be highly appreciated, thank you so much!

 

[kjbeams]

Did you try adding the XS modifier to 17000? Or the 59 modifier?

 

[jenmendoza]

Did you try adding the XS modifier to 17000? Or the 59 modifier?

Hello! The modifier 59 was put on code 17110. For the rest, there is no modifier included.

 

[Mandy76]

17110 would be your primary code and 17000 and 17003 would need modifier 59 on each line, not on 17110.