Question Blue Cross Blue Shield of IL lesion removal denials due to bundled

jchoiesq

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Hi, just wondering if anyone has been experiencing denials from Blue Cross when the claim includes a shave removal (eg. 11300) on one site and destruction of lesion using liquid nitrogen on another site (17000 or 17003) with two different diagnosis codes and a 59 modifier on the 17000/17003. We are seeing denials on the 11300. The same occurs when there's an excision of a benign lesion (11422) billed with 17000.

Has anyone been able to successfully appeal these? Any insight or advice on this would be greatly appreciated.
Thanks,
Jennifer
 

nkrush12

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Have you tried using modifier XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure” instead of 59? We are hit and miss with our shave removals with other procedures. Usually are paid once we send in clinical notes clearly showing different procedure/site from any excisions and/or destructions. But it is a huge time waste on our side since it was coded correctly to begin. :mad:

Nicole
 
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