Wiki Add ons denying as bundled

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sinman0531

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We’ve recently been getting a lot of add on codes denied from MA and Medicare plans when they are billed with 17110. Examples:

99203-25: pays
17110: pays
17000-XS: pays
17003 x12: denied as unbundled/included in previous payment

or

99203-25: pays
17110: pays
17004-XS: pays
11102-XS: pays
11103: denied as unbundled/included in previous payment

Any insight as to why? Just send appeals?
 
Have you added XS modifier to the add on codes? I know it should not technically need the modifier, but there are many MA payers whose editing software makes it "bump" up against the unrelated code and therefore deny.
 
dkissel said:
Have you added XS modifier to the add on codes? I know it should not technically need the modifier, but there are many MA payers whose editing software makes it "bump" up against the unrelated code and therefore deny.
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We’ve had a couple that our outside billers have sent out with 59/XS modifiers that have also denied as unbundled. All the ones I have seen have also been new patient visits, in addition to having the benign destructions.

I’m not on the billing side, so I don’t know if it’s just a matter of sending them back for review, but I literally had 10 different claims forwarded to me over lunch so I could double check the coding.
 
sinman0531 said:
We’ve had a couple that our outside billers have sent out with 59/XS modifiers that have also denied as unbundled. All the ones I have seen have also been new patient visits, in addition to having the benign destructions.

I’m not on the billing side, so I don’t know if it’s just a matter of sending them back for review, but I literally had 10 different claims forwarded to me over lunch so I could double check the coding.
Click to expand...
I'm at a loss then. I would make a phone call to provider inquiry before sending appeals though.
 
For the first code, you don't use 17003 with "x14" as the code explicitly states "second through 14"lesions.
For the second example, how many tangential biopsies were done? 11103 is an add on code and you would need the number of lesions indicated.
This is my best guess.
 
17000 x14 units is correct, this add on code is per each additional. We also include the modifiers on the add on codes. I know that some payers do not require but it seems to help our claims flow though the editing software
fwnewbie said:
For the first code, you don't use 17003 with "x14" as the code explicitly states "second through 14"lesions.
For the second example, how many tangential biopsies were done? 11103 is an add on code and you would need the number of lesions indicated.
This is my best guess.
Click to expand...
 
For the example with codes 17110, 17000 and 17003, codes 17000 and 17003 are column 2 codes with code 17110. The column 2 codes will require the modifier. For the other example, 17110 is a column 2 code with 17004. 11102 and 11103 are column 2 codes with 17110. So codes 17110, 11102 and 11103 will all require a modifier to bypass the edit.
 
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