New and in need of help

Rip

Networker
Messages
53
Best answers
0
Help.
I submitted claim for:
11463-50 Bilateral medial thigh excision of hidradenitis

The charge was not paid - reason:
C04 - code inconsistant with modifier

Help...
do I resubmit as
11463-LT-RT
 

nsteinhauser

Expert
Messages
334
Best answers
0
Cpt 11463 doesn't take modifier -50 so you wouldn't use a laterality modifier (-rt or -lt) either. If it was 2 separate areas, I would code it twice. Some of our payers would require a -59 on the second line, some a -51, some nothing. You'd have to find out from the payer how they want the second line modified so they won't deny it as a duplicate procedure. Hope this helps.
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
Yes list twice with a 59 since the second location is a distinct and separate site. The 51, only indicates that both procedures were performed in the same session.
 
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