help with modifier

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coded a excision of a breast mass 19120 and excisoin of a benign lesion from the back done on the same day as 11404 59. Got rejected on the 11404. Medicare stated the service required a qualifying/service procedure be received and covered referred me to 835 healthcare policy. how should I have coded this. Thanks.
 

mitchellde

True Blue
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Do you have a path report for the excision that gives you the dx of benign? If so then what I use for Mcare with 100% success is the V71.1 which must be the first listed dx code followed by the benign result and the code for the breast mass or the path code for that. Many time Mcare denies a benign excision code with a benign dx code as cosmetic which is non covered. Also watch how you have linked the dx codes to the procedure codes, do not link the dx for the breast to the 11404.
 

Amin C

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pls help me out

Could you tell me which modifier should I use for Cpt 99406 but insurance paid cpt 99386? Both were in a same super bill.
 
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