Wiki getting 11750 pd by Medicare

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KristiB

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Appreciate more experienced help w/ this. Which modifier is needed to get a 11750 pd by Medicare with an office visit? 25 on the E&M didn't do it. Right great toe. CCI edits and Trailblazer cust service/telephone reopening weren't particularly helpful either. Thanks a million!
 
11750

Do you have the Trailblazer LCD for this code? What is the reason for denial? What diag code is submitted?
 
LCD? Denial code is inconsistent w modifier used or required modifier missing. Submitted with cpt's 99212, mod 25, and 11750. Dx 703.0 for 11750, dx 110.1 for 99212. On my ERA only the 11750 is denied for inappropriate modifier. My assumption is a T5 should have been added to claim, but telephone reopening states that modifier is inappropriate, and claim needs to be resubmitted with correct info, not reopened. I do not have processing yet on the 99212. Have a similar claim denied a few days ago, so obviously am not looking at the 11750 w/ E&M correctly.
Really appreciate your help!
 
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