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Identical Minor Surgical Procedures-Modifier 59 or Units?

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  • In Billing
  • September 28, 2011
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By Luann Jenkins, CPC, CPMA, CEMC, CFPC
It is often hard to know if identical minor surgical services should be billed on one line with units, or on multiple lines with modifier 59. The CPT® manual provides some guidance within the code descriptors with terms such as “each additional” or “per,” and Medicare Medically Unlikely Edits (MUE) provide guidance on how many units are allowed per day.
But these resources do not completely answer the question of quantity; therefore, some Medicare Administrative Contractors (MAC) also provide additional quantity lists to assist providers. For example, WPS Medicare developed Quantity Bill Lists to indicate the number of services acceptable per line. Commercial payers may also provide quantity indicators by CPT® code to assist in accurate billing. For instance, 11305 Shaving epidermal or dermal lesion, single lesion, scalp, neck, hands; lesion 0.5 cm or less may be billed on one line with quantity to most payers when removing multiple lesions of the same size and category during the same session. There may be exceptions, so be sure to know your individual payers’ rules.

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