General Surgery Coding Alert

Question: When reporting a lesion excision (116xx) with a layered closure, do we have to add a modifier?


Florida Subscriber

Answer: You shouldn't have to use a modifier when the surgeon performs layered closure to repair a lesion excision site. But depending on the lesion excision's size, you may not be able to report the closure separately at all.

Excision codes 11400-11446 (benign) and 11600-11646 (malignant) describe full-thickness (that is, through-the-dermis) lesion removal with margins and include simple (nonlayered) closures (12001-12018). As CPT instructs, however, -The closure of defects created by incision, excision or trauma may require intermediate or complex closure. Repair by intermediate or complex closure should be reported separately.-

Warning: Medicare and other payers that follow the Correct Coding Initiative (CCI) do not adhere to CPT guidelines, and instead bundle even layered closures for small wounds.

Specifically, CCI bundles intermediate (12031-12057) and complex (13100-13153) repairs to excision of benign lesions of 0.5 cm or less (11400, 11420 and 11440), as demonstrated in the chart below. But Medicare does not bundle intermediate and complex repairs of malignant lesion excision wounds of 0.5 cm or less.

Example: The surgeon removes three lesions (0.5 cm, benign with complex repair; 0.5 cm, malignant with complex repair; and 2.0 cm, benign with complex repair) from a Medicare patient.

You can't claim separate closure for the first lesion because it is 0.5 cm or less. You can claim separate closure for the second excision, even though it is 0.5 cm or less, because it is malignant. And you may report complex repair separately with the final excision because the benign lesion measures greater than 0.5 cm.