Coding for 11300 and 11301

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Capitola, CA
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I have an issue with some of my providers billing 11300 and 11301 with a modifier 59 on 11301. The codes are not bundled if they are done at different sites. I have looked around on the web and found one article that says, " some payers might perfer that you list each removal as a separate line item, with modifier 59 appended to the second and subsequent codes." (General Surgery Coding Alert 2008; Volume 10, Number 9). I am confused as to why the 59 would be appropriate because the codes are not bundled. Can someone please give me some feedback?
Thanks,
Ashli
 

Herbie Lorona

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409
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Yuma
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I would not know why they would want it on there because the two codes are not bundled and a modifier is not needed.
 
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4,466
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Milwaukee WI
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Because they have the money

I know what you mean - it drives us all crazy.

Why do some carriers have their own rules that don't conform to CPT? Because the insurance carrier has the money and can make whatever requirements they choose to make before releasing the payment.

If you have the ability to do so, put an "edit" on your claim processing procedure, so that for provider ABC you add the 59 modifier when you have more than one procedure; that might make things easier on you.

F Tessa Bartels, CPC, CPC-E/M
 
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