Forum - Questions & Answers

Apr 13th, 2016 - gyocumdpm

unbundled service

UHC denied payment of 11057 because they said it was unbundled when paired with 10060 mod 59.
I did some research and found that these 2 codes can be paid together. Does it matter which procedure has the modifier added"

Apr 13th, 2016 - LBAROGIANIS 250 

re: unbundled service

CPT® 10060 would be primary because it refers to one lesion. CPT® 11057 is secondary because it refers to 4 or more lesions and you would put modifier on this code. I would send corrected claim first. I am not sure what diagnosis codes you are using but if you had to appeal after corrected claim, make sure at least 5 lesions are documented.

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