Wiki modifiers on wound care

[tbrady@drsclinic.net]

I have two physicians that also work in a wound care facility. When I am billing the procedures they perform for multiple debridement using modifier 51 they are getting denied. We have these all the time. We bill 11042 primary then 11045 as the add on, then 11043 with modifier 51 and 11046 as the add on to that. They usually will deny the whole thing or pay everything but the 11042. Can anyone help? We have sent in some with modifier 59 on the 11042 just out of desperation. Any help would be greatly appreciated.

 

[eswaranpandiyaraj]

Wound care cases.

Hi ,

If you are billing Multiple Debridement procedure codes please append modifier 59 to column 2 procedure codes.

Here in this case CPT 11042 is meaning for (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) and CPT 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less). As per Code definition also mentioned two different anatomical structures.

Hence, As per CCI need to append modifier 59 to 11042 (Primary Procdures) and don’t use modifier 51.

Reference:
11043
11046
11042-59
11045

Thanks and regards,
Eswaran pandiyaraj.

 

[tbrady@drsclinic.net]

thank you so much