# need help - Our doctor did an excision



## ayen (Sep 8, 2009)

Our doctor did an excision of lesions on a patient & he also did a biopsy of a lesion on the right & the left leg.  The CPT we used was 11100, 11101 & 11400-59.  Medicare only paid 11101 & 11400-59 but did not pay on 11000 saying "not covered when performed during the same session/date as a previously processed service for the patient". What was wrong with it?  there were two different lesions, different site, that's why we used 11100 for the first lesion & 11101 (add=on code) for the second lesion.  I know we are not supposed to use modifier on 11101 because it is an add-on code.  Do I need to appeal this with a modifier?  Any help/suggestion will be greatly appreciated?  Thank you


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## thythaot (Sep 8, 2009)

*biopsy and excision*

-The rule for the 11100-11101 biopsy CPT code: You cannot code a biopsy and removal in the same day, only on different days. Also, no modifier is necessary if the biopsy and excision are performed on separate days.
-With 11400-11471(benign) and 11600-11646 (malignant) excision CPT codes (require size, location):I think you use modifier-59 is OK.
-Select a CPT code only after the pathology report has returned as malignant lesions require different codes and reimburse at a much higher rate.
I hope it can help.

Good luck  

_Jeslyn Nam_ CPC-A


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## FTessaBartels (Sep 15, 2009)

*Two lesions or Three Lesions?*

Were there two lesions or three lesions?

If you have three separate lesions, then I would appeal with the op note and a letter clearly outlining that there were three distinct sites. 

If you have only two lesions and the excision was done after the biopsy, then the denial is correct. 

F Tessa Bartels, CPC, CEMC


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