Otolaryngology Coding Alert

Question: To remove two facial lesions, including one that requires a flap, an otolaryngologist performs 14060-RT, 11643-59-LT and 11642-59-RT.

Two weeks after the surgery, the flap site opens up. The physician restitches it in the office.

Because 14060 has a 90-day global period, the coding staff thinks we shouldn't charge the patient. The otolaryngologist, however, argues that because he had to perform an additional procedure and not just a regular follow-up office visit, we should bill 12011 with a modifier.

How do you recommend we code the encounter?

Texas Subscriber


Answer: First, you should recheck your lesion/flap coding. If the otolaryngologist only removes two lesions, one of which requires a flap, you overcoded the procedures. The flap repair (14060-RT, Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less; Right side) includes the same-site lesion removal (11642-59-RT, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm; Distinct procedural service). You should only code 14060-RT, 11642-59-RT and 11643-59-LT (... excised diameter 2.1 to 3.0 cm; Left side) if the otolaryngologist removes three separate-site lesions: two alone and one with a flap.

For the office encounter, the answer depends on whether 14060 normally requires restitching. CPT includes "normal, uncomplicated care" in a procedure's global package. So if the otolaryngologist performed a minor repair in the office, you should include the uncomplicated care in the original procedure.

On the other hand, if the restitching isn't typical postoperative follow-up care, you should separately report the procedure. You should consider billing the service under three circumstances:

flaps rarely require resuturing

the otolaryngologist had to resuture the complete flap

the reclosure required a significant amount of work. If one of the above scenarios applies, you should report 12011-79 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less; Unrelated procedure or service by the same physician during the postoperative period). Modifier  -79 tells the payer that the repair is unrelated to the adjacent tissue transfer's postoperative period. Therefore, the insurer should bypass 14060's 90-day global surgical period and pay for 12011.

You don't have to worry about how the simple repair relates to the malignant lesion excisions. Both 11642-59-RT and 11643-59-LT have 10 global days. At the restitching encounter, the excisions' postoperative periods have already expired. The repair occurs two weeks after the original surgery.