Forum - Questions & Answers

Aug 17th, 2015 - TerryC 39 

modifier help Please

A patient came into the office for a physical. They ended up having a couple of procedures done also. Dr. billed a 99396,11100/11101x1 17000/17003x1,
90736.
I entered as such.

99396-25
11100 (no modifier I thought -25 would show something was else done)
17000-59 (seperate procedure)
90736 (no modifier)
11101 (no mod "add on" code)
17003 ( no mod "add on" code).
Blue cross ppo denied the 11100 for needing a modifier. Is my billing incorrect and if so what to I need to do. Any help Thank you.

Aug 18th, 2015 - petunia 195 

re: modifier help Please

Looks like the 59 should be on 11100 instead of 17000.

Aug 18th, 2015 - TerryC 39 

re: modifier help Please

Is there a easy answer as to why? I was taught to put the highest value first. Which in my case would be the 11100. I'm confused.

Aug 18th, 2015 - petunia 195 

re: modifier help Please

In most cases that would be correct, but not every case. I am not sure why, but when I run the codes 11100 and 17000 in encoder pro I get this message Per CCI Guidelines, Procedure Code 11100 [BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION] has a CCI conflict with Procedure Code 17000 [DESTRUCTION PREMALIGNANT LESION 1ST]/]. Review documentation to determine if a modifier is appropriate. Encoder Pro says the mod should be on 11100 instead of 17000. Hope that helps some.

Aug 18th, 2015 - TerryC 39 

re: modifier help Please

Thank you for your help!



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