AAPC - Back to school
Results 1 to 6 of 6

Thread: Add on code denied

  1. #1

    Default Add on code denied

    AAPC: Back to School
    Good afternoon all,

    Patient came in for office visit had 2 biopsies done 11100, and 11101 and destruction 17000 done insurance denying add on code for biopsy 11101 due to that cpt code 17000 included with 11101 see below.



  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Did you have THREE separate lesions?

    If you have THREE separate lesions, then you need to appeal with the procedure notes that clearly show this.

    Secondly, If there ARE three separate lesions .... 11100 has a higher RVU value, so I would list that first. Your -59 modifier will go on 17000.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3

    Default Cci

    If you look at the new CCI it tells you that -59 are added to all add-on codes now


    if the original procedure goes with a -59 now the add on has to too.

  4. #4


    and you were corrected the modifier goes on the 11100

  5. #5
    Join Date
    Apr 2007
    Des Moines


    I agree with Tessa and this one depends completely on what the documentation is. If the biopsy and destruction were done on the SAME site, then you can't bill for both. You can't unbundle it. You bill the code with the higher RVU in that case. If a biopsy is done on one site and destruction is done on a completely separate site, then you can bill it. ***Anyhow, you can try to use modifier 51 if your insurance carrier allows that along with the 59 modifier. Here's in example:

    "Exercise caution when appending the two modifiers for Medicare claims on the same date of service. When a carrier requires the use of the -51 modifier it must be used on the service with lower Relative Value Units (RVUs) while the -59 is attached to the service in the second column of the two lists;
    Comprehensive Table and Mutually Exclusive Table. Sometimes, the service in the second column may be the service with the higher RVU.
    For example when billing 17000 and 11100, the -51 would be applied to the 17000 since the RVU for 17000 is less than 11100. For Medicare, you would bill 11100 with the -59 modifier and 17000 with the -51 modifier."

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  6. #6


    Thank you for the information that was very helpful.

Similar Threads

  1. When to use add-on code
    By truegossman@comcast.net in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-12-2014, 11:11 AM
  2. -53 to add on code
    By pertalad in forum Modifiers
    Replies: 0
    Last Post: 03-25-2013, 01:01 PM
  3. add-on code
    By nancy.anselmo@ccrheart.com in forum Cardiology
    Replies: 8
    Last Post: 04-30-2012, 07:57 AM
  4. Add on code
    By chase0702 in forum Modifiers
    Replies: 2
    Last Post: 11-19-2010, 12:53 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.