Wiki Excision of benign lesion - Need help

[jemimah crescentia]

Hi All:

Greetings!

Our general surgeon excised a benign skin lesion approximately measuring 4.2cm including the margins from scalp region & nearly 4.5cm lesion from the right hand on the same date & session, can anyone help with the cpt codes to be used for the procedures done, 11426 can be coded/billed twice???

Thanks in advance for any assistance & help provided on this....

With Regards,
Dr.Jemimah, CPC,CPMA

 

[billing244]

Benign Lesions

Yes you may bill CPT 11426 x2 because 2 separate areas and your ICD-9 will show different areas. Also how was closure performed? Check to see if this may be billed aslo

 

[teresabug]

you need to list them separately:
11426
11426-59 (modifier tells insurance that the 2nd lesion was a different body area than the scalp excision)
Hold the claim until the path report comes back so that you can attach the appropriate icd-9 code.
If simple closure was done, this is included in the reimbursement for 11426; but if intermediate or complex closure was done, you can also bill out a separate CPT. The procedure note has to state the type of closure in case the carrier audits the chart.

 

[jemimah crescentia]

Thanks a lot for all your replies and guidance, also can anyone help me with the guidelines or links to support this usage of cpt 11426 twice for the same claim as this is mostly rejected as duplicate by some payers...

 

[mitchellde]

If you use the 59 or XS modifier and link each dx code to its own line item it should not reject as a duplicate. Many times I have observed that the electronic system will auto link the first 4 dx codes on the claim to each line item. If this is the case you will need to manually unlink the ones that do not apply to that procedure. Listed correctly with the modifier there is no reason for it to deny as a duplicate.

 

[jemimah crescentia]

Thanks for your help and detailed clarification Debra, could you please provide some links or CMS guidelines available as proofs on this...

 

[mitchellde]

Thanks for your help and detailed clarification Debra, could you please provide some links or CMS guidelines available as proofs on this...

In the Medicare manual there is a section on use of multiple units. My question is how did the claim go out? Were your dx codes linked both to each line or separate. It would help to know exactly how the claim was submitted.

 

[jemimah crescentia]

Thanks for yr reply & guidance Debra, I too got the MEU units as "2" for this Cpt procedure from the CMS website, so this means cpt 11426 can be billed twice in the same encounter if it is clinically indicated & justified with documentation. I think this is sufficient for our re-submission...