Forum - Questions & Answers

Apr 21st, 2014 - brvree 1 

Billing Medicare for 11765

My practitioner performed a wedge resection on a pt's big toe after an exam where he also checked the pt's bp, went over the pt's medications, and wrote a new rx for the pt for a new problem. I coded the visit as 99213-25 and 11765. Medicare paid the E&M code, but I'm getting a code 97 denial for the resection. "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated."

Is there another modifier that I'm missing in here? Why isn't medicare paying this?

Apr 25th, 2014 -

re: Billing Medicare for 11765

Was the patient seen for any other procedure in the 10 to 90 days before this one?

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