Wiki modifier 59 - If a pt comes in

[jamiejohnson63@earthlink.net]

If a pt comes in and has an excision of a malignant lesion, repair and destruction the charge would be 11603, 12032 and 17282. Which would get the modifier 59, procedure code 11603 or 17282

 

[mitchellde]

is this 2 different lesions? because you cannot bill for a destruction and an excision of the same lesion. I cannot assist with modifiers without knowing the entire story. Also CCI edits will help with the decision on modifiers

 

[jamiejohnson63@earthlink.net]

yes, they are two different lesions. Excision on arm and destruction on temple

 

[mitchellde]

You will need a modifier on the destruction then and maybe one on either the excision or the repair, you need to check the CCI edits.

 

[prayercoder]

In my opinion, neither should require a 59 modifier. Each excision is from a different type of lesion. Per code description, 11603 is excision of a malignant lesion and 17282 is the excision of a benign/premalignant lesion. So by definition they are different lesions. Also, your diagnosis codes should be specific enough that the reviewer can see the lesions are malignant/benign and the diagnosis specific to the location. Hope this helps.

 

[mitchellde]

17282 is destruction of malignant lesion and while they are in anatomically different locations by code the repair code does include scalp and that is sometimes combined with face in the edits. A dx code will not override CCI edits which is why they should always be checked.

 

[prayercoder]

17282

17282 and 11603 bundle per NCCI with 17282 the > code and 11603 the < code. There is a "1" modifier indicator so, a 59 modifier should be used to indicate a different site.

 

[CatchTheWind]

Per DermCoder, which pulls straight from the CCI edits, the 11603 and 12032 both get modifier 59.