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denails for debridement add ons 11046

  1. #11
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    Medical Coding Books
    We received denials on our add on debridement codes as well and I was told that the MUEs would be corrected effective April 1 and that we should refile these claims. So we did and now we have gotten the same denial again. Has this happened to anyone else?
    Mary Beth Gord, CPC

  2. #12
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by coder1 View Post
    Mitchelde,

    ITS NOT A DUPLICATE, DENIAL IS INCORRECT

    Its listed as 11043 7070570724
    11046 7070570724
    11046 7070570724

    no modifiers


    the 11043 and the 1st 11046 was paid

    If its an appeal issue then I understand, but for every claim is crazy!!!!
    The way you have it listed the system edits will pick up the second 11046 as a duplicate you do need a modifier to stop this just not a 76, you need the 59.
    so it should be
    11043
    11046
    11046 59
    then you should have no problem with the MUE or the duplicate line item.

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
    Default
    If the correct way to bill is
    11043
    11046
    11046-59
    then how do we bill when we come across a patient with a very large wound? I have seen patients with large wounds that were several hundred sq cm and I billed with multiple units and received pymt from commerical payers. However if I billed each add-on code on a separate line item I will run out of room.

    Also according to our encoder, modifier -59 is not an approved modifier for 11046 for CMS.
    Mary Beth Gord, CPC

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