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TxDerm

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Are we able to bill 17110 & 11900 & J3490 all together on the same claim if it was to treat the same area on the body
 
You are going to run into problems. They carrier is going to think you are treating the "same" warts with the claim.

They will also question why you chose one method over the other and not the same treatment for all.

Also, reimbursement for J3490 is "iffy" and you may have trouble getting paid for that. (Unclassified drug). This will require a manual claim and a cover letter.

Perhaps on this claims cover letter, you can also CLEARLY let them know that some were destroyed with candida antigen and others destroyed traditionally with LN2. I.e., separate lesions and why some were treated one way vs the other.

11900 and 17110 are also bundled.

Put an XS (or 59) on the 11900 to indiciate separate lesion(s) that were treated with injection.

17110
11900 -XS (or 59)
J3490
 
modifer needed but the insurances will pay

ellzeycoding said:
You are going to run into problems. They carrier is going to think you are treating the "same" warts with the claim.

They will also question why you chose one method over the other and not the same treatment for all.

Also, reimbursement for J3490 is "iffy" and you may have trouble getting paid for that. (Unclassified drug). This will require a manual claim and a cover letter.

Perhaps on this claims cover letter, you can also CLEARLY let them know that some were destroyed with candida antigen and others destroyed traditionally with LN2. I.e., separate lesions and why some were treated one way vs the other.

11900 and 17110 are also bundled.

Put an XS (or 59) on the 11900 to indiciate separate lesion(s) that were treated with injection.

17110
11900 -XS (or 59)
J3490
Click to expand...
You will need a modifier 59 on the 11900 but we do this all the time and have had no issue getting paid and we have yet to be asked for notes or medical proof. However going into doing this the forst time we did think that might be an issue. so far so ok!
 
candida with cryo

Hello, from my understanding injecting candida into the body creates an irritation and makes the immune system recognize the warts and begin to fight them. Even with 1 wart being injected, it should kick start the body to fight ALL of the warts the patient has. Therefore, payers do not want to pay for cryo and candida in the same visit. I hope this helps! My providers in the office will do both in one visit, and I have to kindly remind them that we will not get paid for both.
 
continued

Sorry I forgot to add, in addition, we do not add a drug code on with the 11900, because as said earlier, it is unlikely to be paid. Submitting just the 11900 has proven so far to give no problems getting claims paid in my office. Hope this helps!!
 
LBernat7 said:
You will need a modifier 59 on the 11900 but we do this all the time and have had no issue getting paid and we have yet to be asked for notes or medical proof. However going into doing this the forst time we did think that might be an issue. so far so ok!
Click to expand...


You are coding incorrectly and this is false claim. The modifier 59 indicicates to the carrier that these services are being performed on separate lesions, separate anatomic areas, etc.

Ultimately you must select a single CPT code based on the most comprehensive service. But unfortunately, you cannot perform both for the same warts.
 
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