Wiki 11402 & 11200 Billed Together

[jrush7779]

Hello,


We billed for an office visit and 2 seperate excisions on the same day of service as such:
99212-25
11402
11200-59

The ov and second excision was paid ( the lower cost procedure), but the 11402 was denied all together . I checked CCI edits and the two procedures can be billed together, so I am not sure what the issue is. UHC CSR states that the modifier should have been on the 11402 instead of on the 11200, so we are now re-billing as such. But I was taught that you append the modifer -25 for the 1st procedure and a -59 to any additional procedure - on the line with the 2nd procedure. Has this changed? Is there a place I can go to find this information.

 

[mitchellde]

the 59 needs to be appended to the procedure that would be bundled into the other. We list the procedure in RVU order highest to lowest but the modifier does not always belong on the second listed, it always belongs on the procedure that requires the modification.

 

[ollielooya]

We came up with the same situation a little bit ago, and yes the modifier should be on the 11402 rather than the 11200. Did you compare both codes against one another in the cci EDITS? When I search mine, the 11200 pulls up as the primary code and the 11402 is sequenced with modifier 59. Unfortunately I read something about where the lesser procedure is NOT always the one to receive the modifier 59, but without digging back into my resources cannot bring up the information. We did refile a corrected claim and the claim reprocessed without a problem--without any denials.

 

[jrush7779]

Thank you both for replying, I have allowed myself to get confused over something so simple. The -25 covers the E/M being done at the same office visit and the -59 goes on the first procedure to cover the additional procedure. I have been so overwhelmed lately and have allowed myself to "overthink" sometimes.

Thanks again.
Jackie Duddley, CPC