Oncology & Hematology Coding Alert

Question: I have a denied claim for a patient who had 11 same-day lipoma removals. The procedures were as follows:

• 24075 right upper arm x 5
• 24075 left upper arm x 2
• 25071 right forearm x 2
• 25071 left forearm x 1
• 25071 left wrist x 1

I tried correcting by using modifier 59 on the procedures that had multiple removals on the same area and modifier 51 when the procedures were on different sides, but still got a denial. What am I getting wrong?

AAPC Forum Participant  

Answer: You were right to use modifiers to correct the denial, but it doesn’t sound like you’ve used them correctly in reporting this situation.

Modifier 51 (Multiple procedures) indicates that a provider performed different procedures at the same session, the same procedure multiple times at different sites, or the same procedure multiple times at the same site. So, you should append modifier 51 to your first instance of 24075 (Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm), for example, as the provider removed five lipomas from the same site.

You should not use modifier 59 (Distinct procedural service) if your provider performed the same procedure on different lateralities. In this situation, you should use modifiers RT (Right side) and LT (Left side) to indicate left or right. However, as your provider performed the 25071 (Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greater) twice on the patient’s left side — once on the patient’s left forearm and once on the patient’s left wrist — you would append 59 to the second 25071-LT.

So, your reporting for this encounter should look like this:

• 24075-51, RT x 5
• 24075-51, LT x 2
• 25071-51, RT x 2
• 25071, LT x 1
• 25071-59, LT x 1