Wiki 11740

[MP555]

Got a denial for the code 11740 needs a modifier.I billed 99213 25 then 11740 mod 59.
Denied 11740.Can someone help me out.What modifier is used here.

Thank you

 

[ellzeycoding]

Why did you put modifier 59 on it? It is not needed.

Was the E/M truly separately identifiable? 11740 is a minor procedure and E/M is included with it. E/M is billable if for a separately identifiable issue (unrelated to decision to perform the evacuation of subungual hematoma

 

[lara1388]

I have the same denial. Modifier missing or inappropriate modifier on the 11740. This one was billed with a preventative visit 99395 with a separate dx than the procedure code. I billed with 59 first on the 11740. Medicare responded with the CO-4 modifier miss/inapp.. Billed with out the 59 on the 11740 and 25 on the 99395, still response was CO-04 with that combination. Are they looking for anatomical modifiers? When you phone Medicare, they can not tell you the modifier they are looking for, not even the group/ class of modifier. Thanks for any help. Lara

 

[lara1388]

I think it is an anatomical modifier they are looking for. I am going to add the modifier T5 for the area and resubmit. I'll let you know how that works out.