Primary Care Coding Alert

Question:

Since the excision and destruction treat separate lesions, you may report both procedures. CCI bundles 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) into 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses]; first lesion).

The edit indicates a modifier is allowed to override the edit when circumstances are appropriate. Modifier 59's definition indicates, "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury [or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual" (CPT Appendix A " Modifiers). Since the excision and destruction involve different lesions as well as different sites, modifier 59 is appropriate to override the edit. To indicate that the excision is a separate lesion from the destruction, append modifier 59 to 11400 (the component code). Your coding should include: