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Thread: 99 modifier???

  1. #1
    Join Date
    Apr 2007

    Default 99 modifier???

    AAPC: Back to School
    Good Morning Coding world,

    I'm having issues with MCD payments for procedures that require multiple modifiers. I read under one state that if multiple modifiers are needed to use 99 and note the description of the modifer (ct,ny)

    Besides that, Mcd is telling me to use a unlisted procedure code for multiple procedures (IL).

    for e.g

    If a clinican performed multiple debridements a 11042 and 11043

    I would bill:

    and unlisted procedure code for 11042 (not sure what the unlisted code would be for debridements)

    I'm having so many problems with MCD. we provide services to MCD patients thru out the US. any help would be appreciated


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    not sure why they said to use an unlisted code. You would bill the 11403 and the 11402 - 59 if these were performed on 2 separate areas. It would help to have the debridement note to see the context of what you are referring to.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Fayetteville, NC


    In North Carolina we would have to bill that 11403 and 11402-51 because NC MCD does not recognize the modifier -59.
    They also do not recognize RT, LT, -50........I hate MCD
    If you perform say 5 I&D's on 5 different locations you have to use -51 (which I disagree with to start with as they are 5 different locations) and they automatically deny 4 of them and pay one. Then you have to send records and play the wait and argue game while they slowly pay one or two and deny the rest as duplicates. Then you re-send records.....It's a broken record. Sometimes depending on what the procedures are it can take over 6 months to get proper payment
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

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