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Wiki Claim denial Help!!

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codecrazy

Networker
Messages
97
Location
Cocoa, FL
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We sent a claim with:
40490 lip biopsy
11101 BX skin, sq tis
11100-51 Biopsy of skin
99202-25 Office visit

11100 and 11101 were denied as inclusive?

HPI: This patient presents for evaluation of a scaly, red papule ont he left nasal sidewall previously removed. Unfortunately, the lesion recurred. It was scraped away in 2001. She alo has a dark spot on the right upper lip that has continued to enlarge over the last several years.

The rest of the office visit documentation is fine.

Procedure reads as: A diagnostic shave biopsy was done for the lesion on the left upper nasal sidewall. A diagnostic 2-mm punch biopsy was done of a representative area of the lesion on the right upper lip. The defect was closed with one 6-0 nylon cuticular stitch. She tolerated the procedures fine.

Help, I am lost.
 
I see only 2 biopsies in the report and yet you have coded for 3. you will need a 59 modifier, so what I see is
40490
11100 59
plus your office visit with the 25
 
I feel the 40490 is best for the lip bx as the physician specifies a bx of a piece of the lip lesion, the 40490 is a code specific for the lip area.
 
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