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Laceration repair- bundling issue

  1. #1
    Default Laceration repair- bundling issue
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    Patient came to the ER and two laceration repairs were performed- Left eyebrow (2 cm) with 3 sutures, face (.5 cm) with tissue adhesive only. Our provider billed 12011 and G0168. CPT G0168 is being denied by insurance (Medicare HMO) as bundled. We have billed with XS modifier and still denied. Can both codes be separately paid with different modifier?

    Thanks!

  2. #2
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    Quote Originally Posted by aekenyon87 View Post
    Patient came to the ER and two laceration repairs were performed- Left eyebrow (2 cm) with 3 sutures, face (.5 cm) with tissue adhesive only. Our provider billed 12011 and G0168. CPT G0168 is being denied by insurance (Medicare HMO) as bundled. We have billed with XS modifier and still denied. Can both codes be separately paid with different modifier?

    Thanks!
    Under the current CMS NCCI, G0168 is allowed for separate payment with 12011 when billed with a modifier, and XS should qualify. The Medicare HMO that is processing your claim, however, may have different policies for bundling or for modifier use (it's possible that they do not recognize XS yet and may still require 59), or it may have simply made an error. I think you would need to take this question up with the payer to get a definite answer.
    Thomas Field, CPC, CEMC

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