# Multiple derm procedures



## thefosterfarm (Sep 29, 2011)

Didn't get any responses on the Family Medicine Forum to this question, let's see if there is anyone in Derm. that could help.

"Just want to pass this one by for other opinions. Here is part of the note:

Cryotherapy to lesion on central chest (previously diagnosed as Actinic Keratosis by biopsy). A 4mm punch biopsy used to biopsy and remove small crusted lesion on superior aspect of left shoulder. Visually, the biopsy removed the entire lesion. As for the SCC in situ just above the left elbow, the area was prepped with Betasept, anesthetized with 1% Xylocaine with epinephrine and the 5mm lesion removed within an ellipse, cut transversely along skin lines. There was a minimum of 1.5 mm of normal skin as border around the lesion (,,,,,,,,,,goes on to describe intermediate closure, note: the pathology report shows a 2 x 0.5 x 0.4 mm lenticular excision of skin was submitted)

What I would like to know is your opinion of the CPT codes and modifiers you would use? I am leaning towards the following:

99212-25 (doctor also discussed acute urinary retention due to new medication, no testing or exam. Sorry didn't include that info above!)
11602-59
12031-59
11100-51-59
17000-51-59

All suggestion and opinions appreciated, Thanks!! "


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## FTessaBartels (Oct 4, 2011)

*Why the -51 modifier?*

Why would you use the -51 modifier at all?

F Tessa Bartels, CPC, CEMC


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## thefosterfarm (Oct 4, 2011)

I guess the quickest reply would be "because we always have",,,,,I know, now a good reason!  Modifiers are not my forte by a long shot.

We had 4 different procedures performed on 3 different anatomical sites. It seems that modifier 59 is appropriate to distinguish this as well as the different procedure on the same anatomical site (the repair after the excision).

In reviewing, it appears that using modifier 51 in addition, is overkill. We have probably used this for a long time out of fear of not getting paid (it probably came up a long time ago and we added it and never reviewed the process again).  I have read a lot of posts regarding this, but I still, quite frankly, feel somewhat confused on their usage. If you have any good educational information of modifiers I would appreciate it!


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## weshelman (Oct 6, 2011)

The primary surgical procedure does not need a 59 modifier.


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