Medical Billing Forum

Coding => Coding => : tabanowa November 22, 2009, 09:08:26 PM

: cpt 11306 and Medicare
: tabanowa November 22, 2009, 09:08:26 PM

I have billed a visit as follows:
99214 w/ 2 modifier 25's
11306 (linked w/ diagnosis 216.3)
17000 w/ modifier 59 (linked w/ diagnosis 702.0)
17003 (linked w/ diagnosis 702.0)

Medicare has paid the 99214, 17000 and 17003, but I get a CO-125 (submission/billing error) on the 11306.  Can someone help me with what's wrong here?

: Re: cpt 11306 and Medicare
: Michele November 24, 2009, 06:35:34 PM

Are you using a modifier on the 11306?  It looks like it may require the 59 modifier as well, since it was for a different diagnosis and lesion.

Michele

: Re: cpt 11306 and Medicare
: tabanowa November 24, 2009, 07:57:55 PM

The first modifier 25 should take care of the 11306, so 11306 should not require a modifier.  The 2nd M25 is for the 17000 codes, which they paid.  I guess I'll try adding a 59 to 11306 and see what happens...

: Re: cpt 11306 and Medicare
: tabanowa November 24, 2009, 08:02:16 PM

OOPS - I just checked my electronic claim and somehow the 2nd modifier 25 was missing.  That would definitely cause a problem!