Billing carecourse ins.

Good morning,

i have a question I am trying to get advice on. If you could be so kind if it's something you can answer your help will be greatly appreciated.

my doctor performed a precedure on a patient who has caresoure ins. On jan, 24th proc. Code 11042 and on jan. 27th he had to do another procedure 12032 using modifer 58 and 78 caresource paid for the frist proc. And denied the second one for the modifiers used. It was later rebill as a corrected claim using modifier 76 they have again denied the claim.
how can I rebill this claim in order for it to be paid??

thank you in advance

re: BILLING CARECOURSE INS.

Modifier 58 is a staged procedure; Modifier 78 is stating you had a complication from the original procedure, in global period. These 2 modifiers are not used together on same procedure code. Was it a complication (78); was it an entirely new procedure, not related to original procedure, in global period (79); was it prospectively planned to do another procedure within global (58)????

re: BILLING CARECOURSE INS.

Coode 11042 is debridement of sub-cu tissues. Code 12032 is a repair. Why were these done 3 days apart if the same site? This is why an op note is needed.

re: BILLING CARECOURSE INS.

Intermediate repair (12031 – 12057) includes, in addition to the requirements of a
simple repair, “…layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.”
In other words, an intermediate repair may be coded if the physician performed a
layered closure or a single-layered closure that required extensive debridement. If the documentation shows that the physician performed a deep layered closure on the
patient’s wound using staples for the method of repair, then the physician would be able to use an intermediate repair code from the surgery section. Or, if the documentation reveals that the physician performed a single-layered closure only but he had to perform extensive debridement in addition to the single-layered closure, therefore going above and beyond normal debridement, the physician may bill for the intermediate repair code.