Wiki Need Help With Coding Please 11042 & 17250

[healing13]

I am hoping someone can help me with this question - when would it be appropriate to bill 11042 and 17250 with a -59 modifier?
thank you for your help
Lisa

 

[FTessaBartels]

Two distinct wounds

If you had two distinct wounds, it might be appropriate to use the -59 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[shannonmangan]

17250 denials

Hello, I need help with denials we are getting when billing out the 17250 code along with an E/M code as well as the code 11042. We do billing for NP's that see patients in nursing homes and we have NP's that do wound care. We bill the E/M code along with 11042 and then sometimes we need to bill the 17250 along with those and the 17250 code is always denied. We bill using a 25 modifier on the E/M code and then a 59 modifier on the 11042. Can anyone help on why they would deny the 17250 code?

 

[abrintle]

17250 and 11042 can be billed together when performed on 2 separate wounds. If billing together then the 59 modifier is appended to the 17250.

 

[shannonmangan]

17250 and 11042 can be billed together when performed on 2 separate wounds. If billing together then the 59 modifier is appended to the 17250.

So are you able to use the 59 modifier twice then because we have the 59 on the 11042 as well. We bill out the E/M code with a 25 modifier and then the 11042 with a 59 so we need to also bill out the 17250 with a 59 as well? Thanks in advance for your help.