Wiki Medicare Bundling Claims

LCRUZ515

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Pawtucket, RI
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Is any body else having a problem with medicare bundling claims. Example we billed 99213-25, 11100, 11101,17000-59,17003.
They are bundling my 11100 punch biopsy with the destruction. I called them and spoke with a rep who told me that I needed a modifier on the 11100. Which to me is incorrect coding. I have another example I billed a 11100 and a 17000-59. They bundled my 11100 again. I have been doing dermatology coding for two years and have allways sent the claims the same way. It seems to me that they want a modifier 59 on every single procedure. If anybody can give me any insight I will really appreciate it.

Thanks
 
morning,
when we have a scenario such as the one you posted we would have coded it as:
17000
17003
11100.59
11101

of course linking the appropriate dxs to the the cpts. That is how we've always coded scenarios such as this, if there is a separate biopsy procedure done.
{that's my opinion on the posted matter}
 
UNfortunately, according to CCI edits, 11100 is the appropriate code for mod-59. Did your carrier change? Ours changed from Noridian to Trailblazers and we are having TONS of issues with them.:(
 
Our Carrier hasn't changed. I actually called medicare again on this and I asked the rep what exactly do they want. Apperently the cci edits change quaterly and apperently it wants a modifier on every procedure code if more than one. I told her that this was crazy and incorrect coding. She told me that this is the only way to get it threw the cci edits. I think thats insane.
 
I am having the same problems with procedures getting denied out for bundled or global. I'm in Ohio so are FI is Palmetto. Would using modifier 79 be appropriate?
 
It is difficult to get a straight answer from Medicare. Government - go figure. But I really think you need to move the modifier to 11000. I think tha will get the claim paid. That is the correct code to put -59 on.
 
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