Dermatology Coding Alert
Modifier -59 Comes in Handy for Multiple Excisions
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Question: The dermatologist excised two sebaceous cysts from the patient's back. One cyst measured 4.7 cm and the other was 3.3 cm. How should I code this? You need to attach modifier -59 (Distinct procedural service) to 11404 to show the insurer that the second excision was separate and distinct from the first procedure. Answers to You Be the Coder and Reader Questions were reviewed by Linda Martien, CPC, CPC-H, National Healthcare Review in Woodland Hills, Calif.; and William J. Conner, MD, founder of Conner Health Clinic, a multispecialty practice in Charlotte, N.C.
Texas Subscriber
Answer: For the 4.7-cm cyst excision, you should report 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm). You should report 11404-59 (... excised diameter 3.1. to 4.0 cm; distinct procedural service) for your dermatologist's removal of the 3.3-cm cyst.
Both 11406 and 11404 are appropriate for three reasons:
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Modifier -59 Comes in Handy for Multiple Excisions
Question: The dermatologist excised two sebaceous cysts from the patient\'s back. One cyst measured 4.7 [...]