10/10/2023

Aetna-Correct Billing for 11043, 15275 and 97605

We're having trouble getting paid for the following CPT code combination, specifically from Aetna. Codes are 11043 15275 and 97605. Diagnosis is L97.413. Whichever modifiers we try to bill it, the 15275 is denied by Aetna. Please advise how to bill this combination so we can get all 3 lines paid.

When billing these three procedures to any insurance company, CPT 15275 should be listed as the first with no modifiers. CPT 11043 should be second, followed by CPT 97605, each of which should be appended with modifier -59-This is only applicable in the event that the procedures were done on different sites/wounds than the skin graft. If the debridement services were done on the same site, modifier -59 may not be used. If Aetna denies one of the procedures as bundled, progress notes, op-reports, and other supporting documentation will need to be submitted to show that separate reimbursement should be made since the procedures were done on different areas of the body.