AAPC - Back to school
Results 1 to 3 of 3

Thread: getting 11750 pd by Medicare

  1. #1

    Default getting 11750 pd by Medicare

    AAPC: Back to School
    Appreciate more experienced help w/ this. Which modifier is needed to get a 11750 pd by Medicare with an office visit? 25 on the E&M didn't do it. Right great toe. CCI edits and Trailblazer cust service/telephone reopening weren't particularly helpful either. Thanks a million!

  2. #2

    Default 11750

    Do you have the Trailblazer LCD for this code? What is the reason for denial? What diag code is submitted?

  3. #3


    LCD? Denial code is inconsistent w modifier used or required modifier missing. Submitted with cpt's 99212, mod 25, and 11750. Dx 703.0 for 11750, dx 110.1 for 99212. On my ERA only the 11750 is denied for inappropriate modifier. My assumption is a T5 should have been added to claim, but telephone reopening states that modifier is inappropriate, and claim needs to be resubmitted with correct info, not reopened. I do not have processing yet on the 99212. Have a similar claim denied a few days ago, so obviously am not looking at the 11750 w/ E&M correctly.
    Really appreciate your help!

Similar Threads

  1. 11730/11750 help please!
    By TLC in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 01-28-2015, 08:26 AM
  2. 21931/ 26115/ 28043/ 11750? 11750-59??
    By MELJNBBRB in forum General Surgery
    Replies: 0
    Last Post: 04-29-2014, 09:38 AM
  3. 21931 / 26115/28043/11750?/11750-59?? Tia
    By MELJNBBRB in forum Plastic Surgery
    Replies: 0
    Last Post: 04-29-2014, 09:36 AM
  4. Modifier for 11750
    By tintin in forum Modifiers
    Replies: 3
    Last Post: 04-18-2014, 01:22 PM
  5. 11730 vs 11750
    By MsDean84 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 08-22-2013, 01:26 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.