Wiki Reimbursement included in another code

[mworm2018]

Patient was seen in our clinic for a follow up of her depression and fatigue. During this visit she asked the provided to take a look at 2 moles and 2 skin tags that were all located on and around the neck. The provider decided to remove both the moles and skin tags. Here is how it was coded out and billed:

99213-25 --> F33.41, R53.83
11305 --> D22.9
11305-59 --> D22.9
11200-59 -->L91.8

Medicaid Nebraska Total Care paid for everything EXCEPT 11200 saying that reimbursement was included in another code. Is there a different modifier that should have been used? Was this coded incorrectly?

 

[sls314]

Patient was seen in our clinic for a follow up of her depression and fatigue. During this visit she asked the provided to take a look at 2 moles and 2 skin tags that were all located on and around the neck. The provider decided to remove both the moles and skin tags. Here is how it was coded out and billed:

99213-25 --> F33.41, R53.83
11305 --> D22.9
11305-59 --> D22.9
11200-59 -->L91.8

Medicaid Nebraska Total Care paid for everything EXCEPT 11200 saying that reimbursement was included in another code. Is there a different modifier that should have been used? Was this coded incorrectly?

According to this document that I found on the Nebraska Total Care website under "Payment Policies," it says that they prefer the X- modifiers over Modifier 59.

https://www.nebraskatotalcare.com/content/dam/centene/policies/payment-policies/CC.PP.020.pdf

 

[shanno-77@hotmail.com]

We are getting alot of denials from Nebraska Total Care with Cpt code 99381 we are using the NU modifier "no referral given" and EP modifier signifies services related to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for Medicaid members under 21, indicating a routine, preventive healthy kids check-up or a medically necessary follow-up. They are stating missing procedure modifiers. Does anyone work with Nebraska total care and able to help us out?