Author Topic: cpt 11306 and Medicare  (Read 3293 times)

tabanowa

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cpt 11306 and Medicare
« on: November 22, 2009, 06:08:26 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?

Michele

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Re: cpt 11306 and Medicare
« Reply #1 on: November 24, 2009, 03:35:34 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
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tabanowa

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Re: cpt 11306 and Medicare
« Reply #2 on: November 24, 2009, 04:57:55 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...

tabanowa

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Re: cpt 11306 and Medicare
« Reply #3 on: November 24, 2009, 05:02:16 PM »
OOPS - I just checked my electronic claim and somehow the 2nd modifier 25 was missing.  That would definitely cause a problem!