Question what modifier do I use?

bevradley

New
Messages
4
Location
Joplin, MO
Best answers
0
Back-End Errors:
CCI edits:
CCI edit failed for CPT(R) codes 11106 and 11102: CPT Manual or CMS manual coding instructions.
Appropriate modifier must be applied to the Column 2 Code. See http://www.cms.hhs.gov/NationalCorrectCodInitEd/ to determine which code in code pair is column 2. [114241]
Front-End Warnings:
CCI edits:
CCI edit failed for CPT(R) codes 11106 and 11102: CPT Manual or CMS manual coding instructions.
 

cpc2007

Guru
Messages
103
Best answers
0
When I run CCI edits on codes 11106 and 11102, there is an NCCI edit, and you are not allowed to apply a modifier to bypass the edit. The reason for this is because the CPT guidelines state not to report two primary CPT codes from range 11102-11107. An NCCI edit with a reason of "CMS or CPT Manual Instructions" is a prompt to start looking at your CPT guidelines or guidelines in the NCCI Policy Manual from CMS to see if there are rules about the scenario you are coding that the code pair might be violating.

In this example, once you have the first primary CPT code (in this case 11106) you report add on codes for all remaining biopsies even if the method of biopsy is different. So in this case if you have one incisional biopsy and one tangential biopsy on a different lesion (which is what I gather from your initial coding of 11106 and 11102), you would actually code 11106 for the first biopsy which is incisional and CPT 11103 (add on code) for the second biopsy which was tangential. This is supported in the CPT guidelines as well which state you can report add on code 11103 with 11102, 11104, or 11106. Changing your 11102 to 11103 provided that you have the documentation to support two different methods of biopsy on two different lesions should resolve your edit.

These skin biopsy codes were expanded in 2019 and the rules for biopsy of skin lesions are more complex than they used to be. I actually have a website (codingmastery.com) where I write articles to help coders in various surgical specialties. I happened to write an article about the new 2019 skin biopsy codes. Here is a link to the article just in case anything else I explain with the guidelines or examples helps you with other scenarios you may encounter: https://codingmastery.com/2019/01/27/2019-biopsy-codes/

I hope that helps -have a great night :)

Kim
www.codingmastery.com
 
Top