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Inusurance Guidelines don't match CCI

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I work in a dermatology practice and lately we have seen several denials when codes 11102, 17000 and 17003 are billed together. I am putting the 59 modifier on 17000 per the CCI edits. The claims are then coming back paying on the 17000 and 17003 but denying the 11102 saying it is included in the payment for 17003. If we put a 59 on the 11102 the claims are being paid, but this doesn't seem correct. My managers are asking me if we should be putting the 59 on the 11102 before billing these out as a rule, but this goes against the CCI. Has anyone else been seeing this or can anyone offer me any guidance in this situation?

Thank you!
 

calderm

New
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Hello, I too work for a dermatology practice. We are getting the same denials. Have you found any updates since you posted your inquiry?
 

danachock

Guru
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185
Location
Brainerd, MN
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Hi stefishel32,
Are you getting denials on the professional side or the facility side (or goodness both)? The reason I ask is when these procedures through CCI edits on the professional side 17000 needs the modifier however it's completely opposite when I run it through the hospital side it states that 11102 needs the modifier. I am unsure how to help......
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Associate Analyst
 
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