Wiki 11642-59

[nelstx2]

received eob back and coding for 99214-25,11642-59 and 11642-59 from previous coder,

medicare paid on one and not the other as duplicate codes,

should one of the 11642 go without modifier and other go with modifier due to lesions on left and right side of nose???? Or should this have been 99214-25, 11100 and 11101 as tissue sent to pathology to confirm what it is.
Thanks

 

[erjones147]

Based on what you have posted, I would go:

99214-25 (assuming a separate, documented E/M was done at that level)
11642-LT (assuming lesions are known malignant and the correct size)
11642-59-RT

 

[nelstx2]

Thank You for the help

 

[mitchellde]

Based on what you have posted, I would go:

99214-25 (assuming a separate, documented E/M was done at that level)
11642-LT (assuming lesions are known malignant and the correct size)
11642-59-RT

You never use lt and rt or 50 modifiers for skin procedures as skin is an organ without laterality. You would need to list as follows
99214 25
11642
11642 59
However you must have the path result to bill the excision.