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multiple procedures/modifiers

Fort Wayne, IN
Best answers
excision - benign lesion cpt 11423 inflamed sebor. ker. dx. 702.11 (neck)
destruction - benign lesion(s) x4 (l. ear, r. ear, cheek, forehead) were removed cpt 17000 actinic ker. 702.0 17000 x 3
All during same visit.
this claim has been denied twice due to modifiers also stating included w/ other svc. I am wanting to be sure I am coding correctly, modifiers, etc.
billing as 11423-59 (702.11)
17000-59-51-99 (702.0)
17003x3 (702.0)
I do not believe the 17003x3 requires a modifier. Is this correct?
Any help/advice appreciated :)


True Blue
Everett, WA
Best answers
Here is my opinion: Your second line may be triggering the denial. The carrier’s system may not be set up to observe modifier 99, and you would not need the modifier 59 or 51. You should not need the modifier 59 for the 17003 if you bill it as one line. If you billed it as 3 separate lines (as many members on this forum would) you would use the 17003, 17003-59, 17003-59 You are correct in adding modifier 59 with the 11423 due to NCI edits of Mutually Exclusive. Hope this sheds a little light
---Suzanne E. Byrum CPC


Raytown, MO
Best answers
When you are billing for multiple lesion removal you would not need a modifier unless you are breaking 17003 out 3x's, then I would use the mod 59 twice. But the description does state 2-14 removals, so in my opinion I would do x3. I would take off all modifiers except for 11423.

11423 - 59
17003 x3

Thanks, Connie