08/24/2017

Proper Billing for CPT Codes 11055, 11042 and 11721

Please help with the following billing issue. I billed 11042 (Dx codes E11.42, I70.201, and L97.512) on the same date of service with 11721- 59 (Dx codes B35.1 and L60.0), and 11055-59 (Dx codes I70.202 and L84). Medicare rejected the 11042 with CO-236, stating additional information required - missing/invalid/incomplete data from submitted claim. This procedure or procedure code/modifier combination is no compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative. Start: 1/30/2011 Last Modified: 07/01/2013. Medicare is now requesting recoupment. Please advise. Thank you.

The correct way to bill this combination of codes is as follows:

CPT Code 11055

CPT Code 11042 with Modifier 59

CPT Code 11721 with Modifier 59

In addition, you can file a corrected claim with the carrier.