Wiki Lesions

[GINA PERRIN]

I have trouble with when my dr. Shaves on ONE LESION and does destruction of another say i use 11305 for my first charge and 17000-59 i get denied by medicare that proc code is inconsistant with modifier or required modifier is missing
any suggestions on what to do?

 

[hkatie]

I have trouble with when my dr. Shaves on ONE LESION and does destruction of another say i use 11305 for my first charge and 17000-59 i get denied by medicare that proc code is inconsistant with modifier or required modifier is missing
any suggestions on what to do?

Gina,

Our office uses an online product to access the CCI edits so that we always have the up-to-date information on which codes are bundled. For 1st quarter 2010, when 17000 and 11305 are paired together, 17000 is the "column 1" code and 11305 is the "column 2". The edits indicate that a 59 is allowed to differentiate the 11305 from the 17000. This ultimately means that, in this case, the 59 goes on the 11305. The trouble is that the CCI edits change each quarter and it often there feels like there is no rhyme or reason to the pairs. Most of the commercial carriers we deal with tend to follow the CCI edits, so our office paid for a year's subscription to an online tool that allows me to enter the codes, set it for whichever quarter my dos was, and then it spits out all the applicable bundles. I love it.

If you are interested in such a tool, I recommend you spend a little time with Google, find 3 or 4 (there are MANY out there and I don't like to recommend one above the others because what you like might be different from what I like,) and try them out. Most of them will you give a trial of 1 or 2 weeks for free so you can decide what works best with your practice. I love having the tool, use it hundreds of times each month, and am so grateful to my manager for authorizing the expense. Good luck.

Best,

Katie Hanninen, CPC, CPCD