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Modifier Conflict

  1. #1
    Default Modifier Conflict
    Medical Coding Books
    I contacted the Correct Coding Initatives regarding the number of units fo code 11045-11047. These codes are not on they list of MUE. The Correct Coding Initatives informed me that the codes above MUE are confidental and aren't released to the public. I was told that modifier 59, 76 could be used if the carrier set for these codes not to be used in units but billed on separate lines.

    The definition of the modifier 59 is used to identify procedures that are not NORMALLY reported together, but are appropriate under the circumstances. Documentation must support a different session,different procedure,different site...etc

    My debate would be how could I use modifier 59 based on the above description. The codes are add on codes that have a primary code based on the sq cm of the wound. These codes would Normally be reported together, Documentation would support the same session, same procedure, same site.

    If anyone suggest otherwise, please help me to understand...Thanks

  2. #2
    Here is something I found under our LCD for Medicare...

    CPT codes 11042-11047 do not refer solely to ulcer size, but also to levels of actual tissue debridement levels (based on tissue type; e.g., partial skin, full thickness skin, subcutaneous tissue, etc.) of independent (non contiguous) skin and other deeper tissue structures. NAS allows payment for an aggregate total of four independent tissue debridements on a given day of service, whether the debridement was performed on one or both feet, per date of service. Any number greater than the aggregate total of four for one or both feet per date of service will result in a denial which may be appealed with documentation justifying the additional services.
    Herbie W Lorona Jr., CPC, CPC-H

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