Wiki modifier 59 on correct cpt

[Kim M Gordon]

I have Medicare denying 3 claims as they state that the procedure is not compatible with another procedure and/or modifier combo same day of service, according to the CCI edits they can go together, another company states i have the modifier on the wrong CPT code. I have always not put the modifier on the primary code/highest priced CPT code per MDCR as you are paid 100% for the 1st one. This is also the first time this has happened all year. This company is saying the following:

I should have a 59 mod on the following
11601 not the 12031, or the 17000 or 17281
11100 not the 11301 or 11300
11100 not the 17110

any guidence on this would be greatly appreciated.

Kim Gordon CPC,CPCD

 

[Lujanwj]

You're going to need -59 on everything except the first code 12031. Every code is bundled into one code or another. If you are sure that all of these codes have nothing to do with each other in any form and are completely separate and distinct, appeal with docs that support the distinctions between all the procedures.