Dermatology Coding Alert

Published on Wed Sep 02, 2009 PDF

Question: My physician removed a malignant lesion and closed a layered lesion at the same time. He bills the codes 11603 and 12032. What is the correct modifier for the second procedure?

Colorado Subscriber

Answer: Since more than one classification of wounds is repaired, you list the more complicated or one that has the higher RVU as the primary procedure -- in this case, 11603 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm). Report the less complicated/valued one (12032, Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) as the secondary procedure using modifier 51.

Why: Appending modifier 51 (Multiple procedures) indicates that the closure is a multiple procedure. Some insurers may reduce payment for codes appended with this modifier. Thus, you should append it on the lesser-valued procedure. This will allow full payment for the more expensive procedure.

When in doubt: Read CPT guidelines for Excision of Malignant Lesions (2009 CPT Professional Edition, page 55, second column) The guidelines for removal of benign or malignant lesions specifically tell us to code a layered or complex closure separately.