11100 not pd with 59 modifier

I've been billing 99202-25 and 11100-59 and we don't get paid for the biopsy (11100). Can anyone please five me a correct coding advice for this situation?

Mar 27th, 2012 - rhorton4 22

re: 11100 not pd with 59 modifier

You do not need modifier 59 with just 1 procedure

Mar 28th, 2012 - andsc1 1

re: 11100 not pd with 59 modifier

it was billed with a 99203-25. sorry.

Mar 28th, 2012 - rphelps 615 1

re: 11100 not pd with 59 modifier

You still should not need a 59 modifier with 11100.

Apr 2nd, 2012 - Codapedia Editor 1,399

re: 11100 not pd with 59 modifier

I agree: the correct coding should be 9920X-25
11100

However, for minor skin procedures, many payers don't recognize an E/M on the same day as an office visit for the same diagnosis. Since the NCCI edits say that the decision to perform a minor procedure is included in the payment for the procedure, many payers question the need for an E/M on that day. Some are more likely to pay when the patient is new, and less likely when established. You might check your payer policies. They may be telling you: we'll pay for one or the other but not both on the same day.

If you billed a 99203, be sure your documentation supports that level of E/M service.