Wiki Urgent - Medicare denying 12011 stating does not support this many/frequency of services.

[Biller2023]

We billed 12011 in 1 line with RT modifier and in another line with LT modifer (each with 1 unit) but medicare denied stating CO-151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Doctor performed simple wound repair on bilateral ears. Each wound was 1.5 cm in length
How do we fix the denial?
Please respond as soon as possible. Thank you.

 

[sls314]

We billed 12011 in 1 line with RT modifier and in another line with LT modifer (each with 1 unit) but medicare denied stating CO-151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Doctor performed simple wound repair on bilateral ears. Each wound was 1.5 cm in length
How do we fix the denial?
Please respond as soon as possible. Thank you.

These were not billed correctly. You'd add up the sizes and bill the correct code. It's not a separate CPT for each ear.

12011 is "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less"

If you're saying the documented repair on each ear was 1.5 cm, that's 3 cm total.

You'd bill 12013 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm"

 

[Biller2023]

Got it thanks so much Susan