Wiki Ulcer coding

[mzkandyd]

I have the following billed to Medicare:
15936
15931. 51

Medicare has paid the 15936 and denied the 15931.51 as not having a qualifying procedure billed together....WHAT am I missing here?

TIA

Kandy

 

[hewitt]

Good question.... The two CPTs are considered to be bundled, but your use of modifier 51 is allowed.... Seems you are going to have to appeal this one. If you speak to them, maybe they will tell you what the REAL denial reason is, or at least explain the one given!

 

[FTessaBartels]

Same ulcer?

You cannot excise the same ulcer twice in one operative session. If these were TWO ulcers, then the modifier you need is -59.

Hope that helps.

F Tessa Bartels, CPC, CEMC