Wiki 11403 x3 was bundled?? Did I goof??

[theaterd]

I work for a PCP but really wanted expert opinion on this, since we don't do this very often at all.

Patient presented for lesion removal, 3 lesions, benign.



After explanation, she was prepped with Betadine initially on the right shoulder which was then draped she had 2 small lesions about 2-3 mm each, which were removed with sharp dissection and sent for pathology. Lesion #1 inferolateral to lesion #2 on the left shoulder. Lesion #3 is the lesion at the nape of the neck. After that hemostasis was obtained with pressure and a bandage. We then went to the nape of the neck and approximately 3 mm lesion was removed after usual prep and drape and anesthesia with lidocaine with epi. Also sent for pathology.

We charged:
11403
11403-51
11403-51
and got 1 paid with a denial on others as redundant/inclusive.

Was the modifier wrong?
Should they have been added together and submitted as one?

As always, any help is MOST appreciated.

Thanks

 

[jholt12]

Hi,
Depending on the Insurance you would have needed a modifier 59 or 76 on second and third procedure codes.

 

[theaterd]

thank you!!

 

[mcpalmeter]

11403 x3 was bundled?? Did I goof??

59 modifier to indicate different anatomical sites.

 

[cynthiabrown]

some insurance will only pay on two, no matter modifier

 

[ABonnell CPC]

Call the insurance company. Many claim processing systems auto deny no matter how its billed. In most cases, you may just need to submit records to support the services billed.

 

[theaterd]

Thanks everyone! Appreciate the help.