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Thread: Claim denial Help!!

  1. #1

    Unhappy Claim denial Help!!

    AAPC: Back to School
    We sent a claim with:
    40490 lip biopsy
    11101 BX skin, sq tis
    11100-51 Biopsy of skin
    99202-25 Office visit

    11100 and 11101 were denied as inclusive?

    HPI: This patient presents for evaluation of a scaly, red papule ont he left nasal sidewall previously removed. Unfortunately, the lesion recurred. It was scraped away in 2001. She alo has a dark spot on the right upper lip that has continued to enlarge over the last several years.

    The rest of the office visit documentation is fine.

    Procedure reads as: A diagnostic shave biopsy was done for the lesion on the left upper nasal sidewall. A diagnostic 2-mm punch biopsy was done of a representative area of the lesion on the right upper lip. The defect was closed with one 6-0 nylon cuticular stitch. She tolerated the procedures fine.

    Help, I am lost.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    I see only 2 biopsies in the report and yet you have coded for 3. you will need a 59 modifier, so what I see is
    11100 59
    plus your office visit with the 25

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default I see....

    So it's not inclusive to 11100 it's inclusive to 40490. Thank you for your help.

  4. #4


    I think 11100 and 11101 is the correct choice for the following service.

    are the best choice
    Vikas Maheshwari
    Operation Manager (Medical Billing & Coding)

  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    I feel the 40490 is best for the lip bx as the physician specifies a bx of a piece of the lip lesion, the 40490 is a code specific for the lip area.

    Debra A. Mitchell, MSPH, CPC-H

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