Wiki Lesion Excision with Flap repair

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cwpierce

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I posted this over in ENT/OTO however it might be more appropriate over here.


Good Morning all,

I have an OTO. Doc who performs a lesion excision of a BCC of the cheek
(11646). A second OTO. Doc with a subspecialty in Plastics does a V-Y Flap repair (14301). CPT guidelines states that the Flap closure will trump the lesion excision however, I was wondering if we would be allowed to bill the respective procedures to each Doc as they are of different subspecialties?

So......


Dr. OTO Dx. Dr. Oto/Plastics

11646 -59 171.0 14301

In other words, will Dr. OTO lose out on all of his/her time and effort excising the lesion to Dr. Oto/Plastics who does the Flap repair or can they both get paid via the question above?


Any thoughts would be appreciated.
 
Same practice? Same Operative Session?

So, are these both done in the same operative session? And are both doctors in the same practice?

I doubt that any insurance will allow you to UNbundle a clearly bundled service just because two different doctors perform the two parts of the surgery.

This is such a well-established convention (i.e. you code ONLY the flap and not code the lesion excision) that the two surgeons would have to have been aware of it.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
It sounds to me that both doctors participated in their own individual parts of the sx. In these cases, I have seen each doctor dictate his part in the sx, including a statement indicating that the other doctor will be dictating his portion separately. Mod 62 is appended to the primary procedure, if that procedure code is applicable for mod 62.
 
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