Otolaryngology Coding Alert

Question: The otolaryngologist excises a skin lesion that returns from the pathology lab as positive for basal cell carcinoma with a positive margin. The lesion is re-excised during the global period of the original excision. How should the second incision be coded to obtain payment?

New Mexico Subscriber

 
Answer: If the excision takes place on a different day, the second excision is paid separately. The second excision is considered a staged procedure, despite the fact that it occurred during the global period of the first excision. Therefore, modifier -58 (staged or related procedure or service by the same physician during the postoperative period) should be appended to the appropriate excision of malignant lesion code. If the re-excision occurs on the same day, only the final excision should be billed.