Wiki Plastic surgery deniel

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Jarant

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Can anyone help with this. We got some denied procedures and I am new at plastic surgery. Here is how it was coded :

11442
13150
15574
11441
13131
11440

The insurance denied the 13150 and the 13131 codes for incident to the primary procedure. Any help would be great and any reference material on this would be appreciated.

Thanks,
Jenny
 
Modifiers needed and Appeal

Most of our payors want to see a -59 modifier on the repair code. This is especially important when you have multiple lesions and multiple procedures performed (you have a flap done in the same body area so they'd be wondering if the closure is related to that procedure). You need the -59 modifier to indicate that this was a separate incision (from the flap and from the other excisions).

Even when using the -59 modifier, I see denials for the intermediate and complex closures resulting from excision of lesions all the time. I even have a "canned" appeal letter, they happen so frequently.

Without seeing the actual op note, I can't really tell if these are legitimate codes in your case, but assuming that they are ...

Appeal the denial, include a copy of the op note; clearly underline the areas that pertain to the closures that were denied; include a copy of CPT guidelines that clearly state that the intermediate or complex closure is to be separately reported. If you have pictures or diagrams that's even better.

Hope that helps.

F Tessa Bartels, CPC, CPC-E/M
 
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help coding surgery

investigate the possibility and appropriateness of using a 59 modifier
 
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