I&D and Biopsy done at different sites

[cheryl.vanklingeren]

Doctor did a shave biopsy on the forehead and an I&D on the right axillary vault on the same day. UHC is denying 11100 as inclusive even after submitting medical records showing 2 different sites. These codes do not bundle so I don't think a modifier would be appropriate. I'm not sure where to go from here, any advice/input would be appreciated!

 

[JesseL]

Doctor did a shave biopsy on the forehead and an I&D on the right axillary vault on the same day. UHC is denying 11100 as inclusive even after submitting medical records showing 2 different sites. These codes do not bundle so I don't think a modifier would be appropriate. I'm not sure where to go from here, any advice/input would be appreciated!

I would just try to put the modifier 59 on the 11100 to override it. Some insurance companies have their NCCI edits screwed up on their systems.

 

[ellzeycoding]

Yes UHC states they follow the NCCI Guidelines, but they have their own "special" edits. The advice above is correct.

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesHtml/ReimbursementPolicies/Rebundling_2016A.pdf


You can also use their claim bundling logic tool (if you have a UHC log-in).

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=a017e61156251110VgnVCM100000c520720a____