Otolaryngology Coding Alert

Question:

Utah Subscriber

Answer:

No, laser lesion destruction in the mouth's vestibule falls under 40820 (Destruction of lesion or scar of vestibule of mouth by physical methods [e.g., laser, thermal, cryo, chemical]). If the physician had instead excised a mucosal or submucosal lip- or cheek-tissue lesion without repair, you would use the code you mention, 40810 (Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair).

Warning: Code only completely distinct additional lesions your surgeon destroyed. If the lesions share borders or are adjacent, do not code separate destructions.

Wait to file the claim until you have the pathology report. The diagnoses may help you to substantiate coding an additional 40820. For instance, if the lip lesions come back as cancerous, and documentation shows they are on the upper and lower lip, you would report on separate lines:

When you have the same diagnosis, for instance, two separate-location upper lip mucosal lesions (140.3), you may be able to report the destruction with 40820 x 2. To avoid the carrier considering the second 40820 duplicate, you may need to append modifier 59 (Distinct procedural service) to the second 40820.

Each state's Medicaid program has their own rules, so you may want to contact your provider representative to find out if they want you to use two units or to use the code twice with modifier 59. The rules are payer and state specific.