Ophthalmology and Optometry Coding Alert

Question: The ophthalmologist removed six lesions from a patient's right upper eyelid in February. In March, he removed six more -- three from the right lower eyelid and three from the left upper eyelid. All of the lesions were less than 0.5 cm in diameter. What is the proper way to code this? Can I code six separate lesion removals in February and six in March?

Illinois Subscriber

Answer: You may code and bill for all 12 lesions. Report one unit of 11440 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) for each lesion, no matter when the ophthalmologist removes them -- or which eyelid he removes them from.

The real challenge in coding multiple lesion removals, however, is determining which modifier to append. Some carriers want you to use modifier 51 (Multiple procedures), although most Medicare carriers will automatically append it for you. Other carriers want the eyelid modifiers E1-E4. And some want both. Ask your carrier for its preference.

Watch out: You cannot add up the lesions to arrive at a larger size. For example, if your ophthalmologist removes two lesions, both under 0.5 cm in diameter, you cannot code 11441 (... excised diameter 0.6 to 1.0 cm) simply by adding the sizes together. Instead, you should report the procedures on separate lines using 11440 twice with the appropriate modifiers.

Resource: For more information on coding for eyelid lesion removal, see "Stop Risking Over $60 Each Time You Report Eyelid Lesion Removal" in Vol. 10, No. 11, of Ophthalmology Coding Alert.