Wiki CPT's for Excision of 2 neck masses

[wynonna]

Help please for neck excision:
3 cm mobile mass deep to the right sternocleidomastoid. There is also a 4 mm nevus on the skin. Proposed elliptical incision line encompassing the nevus is infiltrated with 1-1/2% lidocaine with 1 to 200,000 units of epinephrine. Neck is sterilely prepped and draped in usual fashion. Incision is performed and skin is excised labeled right-sided neck skin. Incision is carried down through the platysma and platysma is elevated superiorly and inferiorly revealing the sternocleidomastoid. Blunt and sharp dissection is performed on the anterior aspect of the sternocleidomastoid with identification of the internal jugular vein. Posterior to the vein was the mass which was dark blue and multilobulated. Blunt and sharp circumferential dissection is performed around the mass and the mass is mobilized. Further dissection freed the mass and it was delivered from the field. The mass was inadvertently opened and large amount of dark watery fluid was released. Mass is sent for histology. Wound is copiously irrigated with saline and hemostasis verified. Incision is closed over quarter inch Penrose drain utilizing 3-0 chromic for the platysma and subdermis and running 4-0 nylon for the skin.

 

[nickelclaw]

Excision of mass, muscle 21556
excision skin lesion .4cm 11420 may need modifier 59.
When the patient is appropriately prepped and the area anesthetized, the provider holds a scalpel or other bladed instrument perpendicular to a benign lesion, not a skin tag, measuring 0.5 cm or less in diameter, including margins, on the skin of the scalp, neck, hands, feet, or genitals. He excises down into the subcutaneous tissue in an elliptical, wedge, or circular shape to remove the entire lesion. He may submit the specimen to a laboratory for analysis. He checks for bleeding and then closes the wound in a single layer.

 

[wynonna]

Thank you for your help. That's what I got, too. Per path: 2 portions of mass, 1 anterior to vein, and the other posterior to vein were excised. 2 pieces with different dimensions, different depths were excised. They total 4.1 cm. Do I bill each individually twice for 21556, and 21556 with mod 59/XS? Or do I bill 21556 once for 4.1 total for 2 pieces?