Wiki Use of Modifier 51 when coding lesion excision & repair

[dyoungberg]

When coding excision of a lesion with simple, intermediate or complex repair, where 2 codes are necessary, should modifier 51 be used on the repair code? Thanks!

 

[FTessaBartels]

Technically vs In Reality

Simple repair is INCLUDED in lesion excision, so should not be coded separately in any case (unless it's a totally different wound ... and you'd use a -59 modifier).

Technically you do not need ANY modifier as per CPT intermediate or complex repair is NOT included in the lesion excision. However, I find that using the -59 modifier is what most carriers want to see. Even then, we get denials, which we appeal with op note and a copy of the page from CPT.

Hope that helps.

F Tessa Bartels, CPC, CEMC