Marina Posted Wed 23rd of January, 2013 17:54:29 PM
I recently billed procedure code 11441 with diagnosis code 216.1. It was rejected with reason "these are non covered because this is not deemed a medical necessity by the payer". Should I re submit with notes or should I add a modifier?
SuperCoder Answered Wed 23rd of January, 2013 19:47:50 PM
Depending on the carrier, you may need to append an eyelid modifier (-E1, Upper left, eyelid; -E2, Lower left, eyelid; -E3, Upper right, eyelid; or -E4, Lower right, eyelid) in order to know the payor about eye lesion. You should also submit notes clarifying your point.