Wiki Medicare Bundling Claims

[LCRUZ515]

Is any body else having a problem with medicare bundling claims. Example we billed 99213-25, 11100, 11101,17000-59,17003.
They are bundling my 11100 punch biopsy with the destruction. I called them and spoke with a rep who told me that I needed a modifier on the 11100. Which to me is incorrect coding. I have another example I billed a 11100 and a 17000-59. They bundled my 11100 again. I have been doing dermatology coding for two years and have allways sent the claims the same way. It seems to me that they want a modifier 59 on every single procedure. If anybody can give me any insight I will really appreciate it.

Thanks

 

[dmaec]

morning,
when we have a scenario such as the one you posted we would have coded it as:
17000
17003
11100.59
11101

of course linking the appropriate dxs to the the cpts. That is how we've always coded scenarios such as this, if there is a separate biopsy procedure done.
{that's my opinion on the posted matter}

 

[Lisa Bledsoe]

UNfortunately, according to CCI edits, 11100 is the appropriate code for mod-59. Did your carrier change? Ours changed from Noridian to Trailblazers and we are having TONS of issues with them.

 

[LCRUZ515]

Our Carrier hasn't changed. I actually called medicare again on this and I asked the rep what exactly do they want. Apperently the cci edits change quaterly and apperently it wants a modifier on every procedure code if more than one. I told her that this was crazy and incorrect coding. She told me that this is the only way to get it threw the cci edits. I think thats insane.

 

[alixg]

I am having the same problems with procedures getting denied out for bundled or global. I'm in Ohio so are FI is Palmetto. Would using modifier 79 be appropriate?

 

[Lisa Bledsoe]

It is difficult to get a straight answer from Medicare. Government - go figure. But I really think you need to move the modifier to 11000. I think tha will get the claim paid. That is the correct code to put -59 on.