03/25/2024

Excellus BlueCross Denial for 97597 Billed with 11057 and 11721

OUR 97597 WAS DENIED, AS INCLUSIVE, WHEN BILLED WITH 11057 &11721 (WHICH WERE BOTH PAID) WHAT MODIFIER WOULD I USE FOR THE 97597? WOULD 79 BE APPROPRIATE, AS XS WAS ALREADY DENIED?

The nail debridement should be billed with either modifier -59 or -XS to Blue Cross. Either would be appropriate to show that the wound debridement should be paid separately from the routine foot care. If the procedure has been bundled with use of one of those modifiers, supporting documentation needs to be sent to Excellus to prove that the two procedures should be paid separately. Appealing with office notes is the only way to get additional reimbursement if the claim was initially billed with appropriate coding.