help w/medicare billing. I billed 11721 and then 17000 mod59 to medicare each code having its own sep dx and the 17000 was denied by mcr stating level of svr not substantiated.
any insight is appreciated
help w/medicare billing. I billed 11721 and then 17000 mod59 to medicare each code having its own sep dx and the 17000 was denied by mcr stating level of svr not substantiated.
any insight is appreciated
I am not very clear about the meaning of the term - level of svr. Does it mean level of severity? If yes, you may need to check whether the documentation clearly proved the medical necessity for the lesion removal. The CCI edits latest evrsion does not bundle these 2 CPT codes and therefore adding modifier 59 may not be necessary with one of the codes just to show it as a different Px from 11721. You may add mod. 59 only in case the 2nd Px has a separate incision / separate time of the day of Sx / separate site on body etc. Please verify if adding modifier 59 is absolutely necesary, because CCI does not implement any bundling issue to code these 2 CPTs together.
You need to check the LCD (local coverage determination) to get your answer because to bill CPT 17000 there are certain DX which are only covered as per the severity level.
http://www.supercoder.com/cms-carrier/lcdncd/
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