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General Surgery Coding Alert

Reader Questions:

You'll Get Mixed Signals on Complex Closure With Soft Tissue Tumor

Published on Fri May 28, 2010

Question: Based on the CPT description and notes, it appears that the new soft tissue tumor excision codes don't include complex closure. Our computer billing program, however, will not let us report any complex closure codes with any soft tissue tumor excision codes. Should we be billing the complex closure in addition to the tumor excision codes using modifier 59?Pennsylvania SubscriberAnswer: Although CPT states that you can bill for complex closure (13100-13160) in addition to the soft tissue tumor codes added in 2010, Medicare has stated that the excision/resection codes include simple, intermediate, and complex repairs. That means you'll need to bill these cases based on individual payer rules. CPT 2010 includes 72 new/revised 20000 level codes for soft tissue tumor excisions and resections that describe location, size, depth, and malignancy -- for instance, 21935 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of back or flank; less than 5 [...]
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