Wiki Medicare cci

[LACEY13]

Can somebody with an updated CCI tell me if medicare now requires a 59 on the 11101. All of the private insurnaces are now requiring this which is a problem when they are a secondary cross over from Medicare. Thanks for you help

 

[mitchellde]

what are the other codes on the claim?
Will documentation support a 59?

 

[LACEY13]

17000 11100 11101 and yes there is support to document a 59. thanks lacey

 

[mitchellde]

you need the 59 on the 17000 or the 11100, you need to look it up to see which one is the component code, you do not need a 59 on the 11101 unless you are listing more than one 11101 in which case you will use a 59 like this
11100
11101
11101 59
11101 59

 

[DeeCPC]

Just checking...so there is one AK destroyed and 2 completely different lesions that are biopsied?

If so, it should look like this
17000
11100-59
11101
Seems odd but not the oddest cci edit out there

 

[mitchellde]

Yes if the 17000 is the comprehensive code. The 11101 by definition is already an additional lesion, these are bundled since the biopsy of a lesion is essentially the destruction of part of it. So if it is the same lesion you can do one or the other but it makes no sense to biopsy it and then before the path result is returned you destroy it. So to show that you have 2 separate lesions you add the 59. I have not checked the CCI edits recently so it is important to do that since the modifier must be on the one that is the component. But the 11101 needs no modifier since its distinct nature is built intot he code description.