Wiki Excision with Repair

[krssy70]

Hello,

Just looking for some clarification. When coding for lesion excisions (11400-11446 or 11600-11646) and an intermediate repair was done, What modifier would be appended and to which code. Looking at a AAPC article from coding edge, it states code the repair first, and then add 51 to the excision code.

Is this correct? Hoping to see what others coders do in these type of scenerios.

Thank you
Kristen

 

[danskangel313]

If you read the guidelines in the CPT book, they explain how to code for this. Here's some of the guidelines, but I suggest you read them all to make sure you are coding correctly.

"The closure of defects created by incision, excision, or trauma may require intermediate or complex closure. Repair by intermediate or complex closure should be reported separately. For excision of benign lesions requiring more than simple closure, ie, requiring intermediate or complex closure, report 11400-11446 in addition to appropriate intermediate (12031-12057) or complex closure (13100-13153) codes.

The closure of defects created by incision, excision, or trauma may require intermediate or complex closure. Repair by intermediate or complex closure should be reported separately. For excision of malignant lesions requiring more than simple closure, ie, requiring intermediate or complex closure, report 11600-11646 in addition to appropriate intermediate (12031-12057) or complex closure (13100-13153) codes."

You would code the excision and then the repair. Modifiers are not necessary. I'm not sure under what circumstances a repair would be done prior to the excision.

 

[CodingKing]

Intermediate repair may have a higher RVU than the procedure which is why the repair might be seen listed first on the claim. However, the list in RVU order isn't mandatory anymore. Most billing systems will automatically list in RVU order and payers system will typically ignore the order anyways. Modifier 51 would go on the lowest RVU code then again most payers ignore where you put the 51 and move it around if necessary. I don't believe there are any NCCI edits for intermediate or complex when billed with an excision so modifier 59 shouldn't be necessary.