Otolaryngology Coding Alert

Question: My otolaryngologist is going to excise a basal cell carcinoma from a patients ear. We would use code 11642 (excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm). Then he is preparing a flap behind the ear to be advanced at a later date (15630, delay of flap or sectioning of flap [division and inset]; at eyelids, nose, ears, or lips). In approximately three weeks, he will do the final repair and flap release (13151, repair, complex, eyelids, nose, ears, and/or lips; 1.1 cm or 2.5 cm) with modifier -58 (staged or related procedure or service by the same physician during the postoperative period) attached. Are the codes Ive noted the correct way to bill these two surgeries? Code 13151 says use modifier -58 if this closure is in the global period.

Anonymous Washington Subscriber

Answer: The reader has coded this procedure correctly, says Susan Callaway-Stradley, CPC, CCS-P, a coding specialist and educator in North Augusta, S.C. According to CPT 2000, modifier -58 should be used when a procedure is planned prospectively at the time of the original procedure [staged].

Otolaryngologists also should note that even though simple closures are included in the original excision, layered (intermediate) and complex closures are not, which allows the 13151 to be billed separately (in this case, three weeks later).