Wiki Need help with the excision coding

Create Wiki
M

Metroderm

Networker
Messages
56
Best answers
0
Dx: Calcinosis Cutis
Location: Scrotum.
The physician had to made 5 incisions of 1 cmx 1 cm to remove all lesions in area (3 left x 2 right)
CPT: 11421
How should I code this? 11421 on one line since it's one area? or 11421 on five separate line with modifier 76?
The physician documented each incision separately ("A fusiform excision was performed" and all five lines documented exactly the same.
We have one specimen bottle for this procedure.
 
Last edited:
Calcinosis cutis is a benign condition, but I would await the pathology to confirm.
If each excision is precisely 1.0cmx1.0cm (including the specimen plus margins), 11421 is the correct code. I will note it is highly suspicious that each of 5 were all exactly precisely the same size to the mm. (I think it was lazy documentation, but I digress.)
Modifier -76 is not appropriate. That is for a repeat procedure on the same day. This was not repeat procedures, but rather 5 distinct excisions. Modifier -59 would be the correct modifier. Depending on the carrier, they may want:
11421
11421 -59 x4
OR
11421
11421-59
11421-59
11421-59
11421-59
I will note that it is highly likely this will not be properly processed and paid the first time without additional information being provided. You should be prepared to write an appeal letter and submit the notes.
If pathology came back as malignant, the coding would change.

Here are 2 good AAPC articles about lesion excisions:
 
Depending on the payer we just code by quantity with no modifier up to MUE (3 for this procedure) then separately bill the additional units with modifier 59. I agree with Christine, those units over MUE will probably need appeal or reconsideration with notes.
 
Correct. I agree with @csperoni.
1. Although, benign and malignant tumors can cause calcification. Only reason why I asked is to narrow down codes that aren't biopsy related.
2. You'll need to obtain the lab/pathology results first. All five lesions should be tested to determine codes.
3. Then, you'll need to measure all lesions & add all together to determine code(s).

 
Young_CodeHopper said:
Correct. I agree with @csperoni.
1. Although, benign and malignant tumors can cause calcification. Only reason why I asked is to narrow down codes that aren't biopsy related.
2. You'll need to obtain the lab/pathology results first. All five lesions should be tested to determine codes.
3. Then, you'll need to measure all lesions & add all together to determine code(s).

Click to expand...
#3 is worded that I would interpret as add all the sizes, and use 1 code. The lesion excisions are not added together. They are coded individually.
Repairs of the same area are added together. But unless the repairs are intermediate or complex, they are not reported separately.
 
csperoni said:
#3 is worded that I would interpret as add all the sizes, and use 1 code. The lesion excisions are not added together. They are coded individually.
Repairs of the same area are added together. But unless the repairs are intermediate or complex, they are not reported separately.
Click to expand...

csperoni said:
I can see that. Honestly though it depends on the path results, length, diameter and margin. *hence: Code(s)*
  • Your first source:
    • "Step 5: Report Each Lesion Separately When the physician excises multiple lesions, code each lesion separately, assigning a specific CPT® and ICD-10-CM code for every lesion treated. When coding for multiple excisions, you should append modifier 59 Distinct procedural service to the second and all subsequent codes describing lesion excision in the same anatomic location. To demonstrate our rules at work, let’s consider two examples: Example 2: The physician removes three lesions from the right arm. Pathology determines that two of these (with excised diameters of 1 cm and 1.5 cm) are benign. The third lesion (excised diameter 2.5 cm) returns malignant. First, report the excision of the malignant lesion (the “most extensive” procedure) using 11603 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 2.1 to 3.0 cm. Next, report the benign lesion excisions using 11402-59 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm and 11401-59 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm."
  • Your second source:
    • "Multiple Excisions Require a Modifier
      Treat each lesion excision as an individual and separate procedure, and link a verifiable diagnosis to each individual CPT® code for multiple excisions. Append modifier 59 Distinct procedural service to the second and subsequent codes describing excisions at the same location to avoid duplication denials. Example 3: The surgeon removes three lesions from the left arm, with total excised diameters of 0.5 cm (benign), 1.5 cm (benign), and 2.0 cm (malignant). Proper procedure and diagnosis coding is 11602 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 1.1 to 2.0 cm with 173.6 Other malignant neoplasm of skin, skin of upper limb, including shoulder. 11402-59 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm with 216.6 Benign neoplasm of skin; skin of upper limb, including shoulder. 11400-59 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less with 216.6"
Click to expand...
 
Normally the size is documented due to the margins being removed as well. In fusiform excisions, the size is done to facilitate closing the skin, not getting the margins. This is the reason why they are all the same size, it's for better skin closure. This kind of excision creates a linear closure rather than a round one, which is more difficult to close.
 
Last edited:
You must log in or register to reply here.
Top