11421 - 5 removals

nmor013

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Need help on this one...
Have 5 warts excised 1cm ea. Guidelines indicate to code each lesion seperate. This may be a stupid question but I've never had to code a removal like this one...does it literaaly mean what it states? Or can I code 5 units??? :confused:
 

jbrashear

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11421

Did the provider perform adjacent skin transfer along with the excisions? If that is the case, then I would say 11421 @ 5 units. This section of codes does not require that you add the diameters together. According to the AMA 2010 CPT, you "Report seperately each benign lesion excised."

The other scenario would be simple, intermediate, or complex closure excision of the benign lesions. In this case you would code 11401 @ 5 units because no "adjacent tissue transfer" was performed in conjunction.

Can't wait to hear what everyone else has to say!

Janice B
 
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Need to see the procedure note

For an accurate response to your question, please post the procedure note.

Excision of benign lesions is reported per each leasion (NOT x 5, but each on a separate line with appropriate modifier on 2d and subsequent lines).

IF intermediate closure is required, then you would ADD the lengths of repair of similar type and body location together before coding.

IF adjacent tissue transfer is used, this already includes the excision of the lesion, so the excision is not coded separately.

Read ALL the guidelines on lesion removal, wound repair, and tissue transfer carefully for full guidance. These are found in your CPT book.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

jbrashear

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11421

Tessa's explanation is correct. I don't know why I was thinking at five units! Lol And now that I read my last post, I am noticing it is badly written and totally confusing, although not too awful for a first-time poster. You gotta start somewhere!

So, assuming we have no intermediate or complex closure and there is no adjacent tissue transfer, we code the procedure as 11421 on the first line. Then 11421 -51 for the next four lines. I just want to make note that the all five lines are code 11421-51 if all excisions took place in the anatomic sites described by that code. You didn't specify anatomic sites in your post, so I can't tell.

Hope that's better!

Janice B, CPC
 

mitchellde

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no you need
11421
11421 -59
11421 -59
11421 -59
11421 -59
The 59 modifier is the one that will tell the payer to pay each one as a distinct and separate procedure. The 51 modifier says they were all performed in the same session. You should check with your payer first on the 51 modifier, as some payers are no longer needing it and have dropped it from the edit system. if they do still use it the list the 51 after the 59.
 
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11421 is correctly coded for excisions done on the anatomic site, i.e.,scalp, neck, hands, feet, etc., and would be billed 5 times, each separately, if all lesions are in the same site. After the first lesion billed, you would inlude modifier 59 on each lesion code thereafter. You did not mention closure, so I assume it is a simple repair (closure) on each. The sum of lengths of repair on all 5 would be 5 cm (in accordance to the size mentioned) and 12002 would be reported. The following is billed:
14221
14221 - 59
14221 - 59
14221 - 59
14221 - 59
12002 (if Simple Repair)

Make sure your documentation specifically indicates the anatomical site, measurement of each lesions(s) plus margins.

Sandra E. Wells, CPC
 

mitchellde

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11421 is correctly coded for excisions done on the anatomic site, i.e.,scalp, neck, hands, feet, etc., and would be billed 5 times, each separately, if all lesions are in the same site. After the first lesion billed, you would inlude modifier 59 on each lesion code thereafter. You did not mention closure, so I assume it is a simple repair (closure) on each. The sum of lengths of repair on all 5 would be 5 cm (in accordance to the size mentioned) and 12002 would be reported. The following is billed:
14221
14221 - 59
14221 - 59
14221 - 59
14221 - 59
12002 (if Simple Repair)

Make sure your documentation specifically indicates the anatomical site, measurement of each lesions(s) plus margins.

Sandra E. Wells, CPC
A simple repair is inclusive to the excision and is not reportable.
 
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