Medical Billing Coding - Mod 59 on excision & repair codes, cpt, codes
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Thread Topic: Mod 59 on excision & repair codes
Topic Originator: Kim
Post Date February 18, 2016 @ 11:47 AM
Mod 59 on excision & repair codes

February 18, 2016 @ 11:47 AM Reply  |  Email Friend   |  |Print  |  Top

I've been having an issue with insurance denying CPT 12032 & CPT 11401 with same ICD9/10 code. Typically this never used to have to have a 59 on either CPT, all of a sudden it is being considered bundled. So when I put a 59 on the repair code 12032 it paid. Can some one explain to me what changes occured? bc i have a claim with 2 excisions & 2 repair codes and I can not figure out where the 59's are suppose to go.

March 10, 2016 @ 10:03 AM Reply  |  Email Friend   |  |Print  |  Top

Hi Kim. I do not see a CCI edit for 12032 with 11401, but the insurance in question may have their own bundling rule. There is a CCI edit that says 12032 would deny against 11400, but a modifier could be added to 12032.

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