See what Activus does
A flap line zeroed over a diagnosis already sitting on the line
Claim. Delayed bilateral DIEP flap after mastectomy, filed on one line with modifier 50, plus a port removal.
Clinical picture. Reconstruction after bilateral mastectomy with chemotherapy finished, documented and attested before filing.
Denial rationale. The carrier returns the flap line at zero under CO-11, the diagnosis inconsistent with the procedure.
Published policy. The 837P makes the first pointer the line's primary. No rule says which primary this carrier accepts. Its own remits do.
| CPT | Dx | Mod | Units | Charge | Outcome |
|---|---|---|---|---|---|
| S2068 | BAC | 50 | 1 | 168000.00 | — |
| 36590 | D | —— | 1 | 1850.00 | — |
| 69990 | BA | —— | 1 | 1900.00 | — |
| CPT | Dx | Mod | Units | Charge | Outcome | |
|---|---|---|---|---|---|---|
| receiving charges | ||||||
Fictitious sample cases. Patient, provider and clinical details are invented. The probabilities, support counts and intervals shown are computed over a synthetic corpus by the same code path that runs on a client’s own remits. No real payer data appears on this page.