Forum - Questions & Answers

Feb 21st, 2014 - billinglady 9 

multiple procedure denial

HELP!! I work in a family practice and the doc removed 7 lesions in various locations on a patient's back. Unfortunately, he didn't document exactly where, as in, R or L side. 5 of the lesions are 11300 and the other 2 are 11402 based on size and location. The 2 11402 were sent to pathology and came back with ICD9 of 216.5. That is the code he selected for the others, as well. I sent the claim with 2 lines as follows:

11402 with 2 units and 11300 with 5 units. The 11402 were paid and 3 of the 11300 were paid with 2 being denied with remark code of "payment adjusted because the pater deems the information submitted does not support this many/frequency of services.

Should I have entered them line by line with 59 modifier on all of them? Or any other help would be appreciated. Thanks in advance



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