Wiki Coding 21930

[csprosty]

Hi Im a new coder and a bit perplexed about all the lesion codes. The physician coded a 21930 for removal lesion that is 8-9 mm in size with changing colors. Is this the correct code to use for a mole that is changing colors? The insurance denied it saying it is a missing, invalid, or incomplete procedure code. It was billed with a 36415 and a 25 modifier. I would appreciate any information or web sites that teaches how to code things like this.

 

[ddaspooner]

Hello! The code the physician selected is actually a removal of a LIPOMA(soft tissue excision), and would only be used for that diagnosis. Depending on the LOCATION of the mole removed and HOW it was removed would depend on the code you used. I'll list a couple examples.

9mm benign excision on the trunk 11401
9mm shave on the trunk 11301

If there was a closure on the excision you would also include the closure code... although there may only have been a simple closure in which case you would not bill for.

Also, if it were a true lipoma the simple and intermediate closures are included in the lipoma removal code (21930)

As far as the 36415 ( collection of blood by venipuncture) not sure what you used that code for, as I have never used it for dermatology.

Another thing, I checked the CCI for the 2 codes that you did use, and neither are requiring a modifier. And a 25 modifier is for office visits, if two procedures were done and one needed a modifier you would use XS.

Hope that helps!! Good luck.