Otolaryngology Coding Alert

Question: I submitted a claim for 11100 and 11101-59, but the insurance denied it. What did I do wrong?Pennsylvania SubscriberAnswer: The insurance denied the claim because +CPT 11101 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; each separate/ additional lesion [List separately in addition to code for primary procedure]) is an add-on code, meaning you should not report it with a modifier. You should report add-on codes with a main code, to denote services extending beyond the primary code. In this case, you'll use 11101 for a second or subsequent biopsy(s).Suppose your otolaryngologist performed a complex flap reconstructive procedure that you know you should report with 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm). Now suppose the size of the reconstruction effort was much larger than the measurements denoted in 14301's descriptor.That means you should report [...]