Primary Care Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Our family physician excised a benign skin lesion of 2 centimeters and destroyed five warts on a patient. If I use 11400, 17000 and 17003x4, should I use modifier -59 (distinct procedural service) or modifier -51, and on which code should I append it?

Ohio Subscriber


Answer: First, you would not use 11400 (Excision, benign lesion, except skin tag [unless listed elsewhere], trunk, arms or legs; lesion diameter 0.5 cm or less) for the excision of the skin lesion because it only includes lesions up to 0.5 cm in diameter, and the skin lesion in question was 2 cm. Instead, use 11402 ( lesion diameter 1.1 to 2.0 cm), assuming the lesion was on the trunk, arms or legs. Code 11402 has a relative value of 4.34 (nonfacility) while 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) has a relative value of 1.73 (nonfacility).   
 
In reporting the excision of a benign skin lesion and the destruction of five warts, you would list 11402 as the primary procedure because it has the higher RVU. Attach modifier -51 (Multiple procedures) to 17000 and 17003x4 (... second through 14 lesions, each). Coders should not adjust the charges themselves; the insurance company will do so. Some payers, like Medicare, will reimburse for the primary procedure, 11402, at the full allowable amount and pay the lesser procedures at a reduced allowable amount (e.g., 50 percent).