Wiki Code 131__

[nharrison2]

I am having the hardest time getting these codes that start with 131 paid by any insurance with sending the notes. The description of the code is noted in the notes but I don't know what the insurance companies are looking for! Can someone help or has anyone seen this? This what is in my doctors notes:

"Excision of benign lesion (diameter 30mm) on upper back with complex closure (length 35mm)
Excision of benign lesion (diameter 20mm) on abdomen with complex closure (length 25mm)
Closure of back open wound.
Local infiltration was injected until the patient had adequate analgesia into the back and abdomen.
The skin was then prepped and draped in the usual sterile fashion, keeping important landmarks in view at all times. The patient's skin was first checked for appropriate anesthesia in the area.
Incision was made with a 15 blade scalpel on the previously drawn lines to ensure correct margins. The incision was taken down to the subcutaneous fat.
The lesion was then excised with a scalpel from the subcutaneous fat, no muscle or fascia was entered.
There was no evidence of abnormal masses or tissue were appreciated below the lesion.
Flaps were made with EXTENSIVE UNDERMINING to mobilize the tissue for a tension free closure.
The wound was checked for hemostasis.
All bleeding was stopped and the wound was cleansed and closed in multiple layers with an absorbable suture (one deep layer of interrupted sutures).
Then the skin was closed with a absorbable suture."

I check the location. I check the lengthen but they say that code 13101 is not supported. What is missing?

Thanks!

 

[Pam Warren]

What is the diagnosis? They may have considered this cosmetic? The procedure codes are correctly assigned based on size. Was a -59 modifier assigned to the second lesion?

 

[nharrison2]

D48.5 D22.5 D22.9
99204-25
13101
11402
11403
this is what is billed so no 59 modifier

 

[nharrison2]

with the size you wouldn't add them together and go with the biggest code? You would two codes with a 59?

 

[Pam Warren]

with the size you wouldn't add them together and go with the biggest code? You would two codes with a 59?

That's only for multiple repairs, not excisions.

Although 'extensive undermining' and multiple layers were done, that's also the language used for an intermediate closure. The difference is that there was no debridement, nor was there documentation to support that more than layered closure is required. I would recommend resubmitting with an intermediate closure, because these are smallish, benign lesions, there was no debridement. I found this video on intermediate/complex closures... hope this helps.

Also, depending on the payer, some surgical services are covered only in in- or out-patient areas. So they're not expected to be covered in an office setting.