13101 and 13102

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I work for a plastic surgery group. We billed for a bilateral capsulotomy and repairs for the closure. BCBS denied the 13101 and 13102 x 6 (both with a 50 modifier)stating that it needs the appropriate code for these services. Is a 50 mod used when coding these? Or should we have not used a 50 mod?
 

thomas7331

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Modifier 50 is not appropriate for closure codes - per the CPT guidelines, "when multiple wounds are repaired, add together the lengths of those in the same classification...and from all anatomic sites that are grouped together into the same code descriptor." So you would never report these codes bilaterally or multiple times at the same encounter since the code(s) billed must reflect the lengths of all of the wound at all sites in the group, and not each wound reported separately.
 
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Modifier 50 is not appropriate for closure codes - per the CPT guidelines, "when multiple wounds are repaired, add together the lengths of those in the same classification...and from all anatomic sites that are grouped together into the same code descriptor." So you would never report these codes bilaterally or multiple times at the same encounter since the code(s) billed must reflect the lengths of all of the wound at all sites in the group, and not each wound reported separately.
Thank you!!
 

Orthocoderpgu

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I would verify that "complex" closure is documented. Go through your CPT book and go over the requirements for complex repair. Make sure that all requirements are documented. I code orthopedic surgeries, so when you stated capsulotomy I'm thinking a joint capsule, not this.
 

thomas7331

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Yes, agree. I don't know what code you're billing for the primary procedure here, but I'd add that I think the complex closure is bundled to a breast capsulotomy and wouldn't be reported in addition. Closures are usually incidental to most major procedures.
 
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Yes, agree. I don't know what code you're billing for the primary procedure here, but I'd add that I think the complex closure is bundled to a breast capsulotomy and wouldn't be reported in addition. Closures are usually incidental to most major procedures.
Thank you! I'm new to plastics so this is helpful. I rebilled without the 50 mod and will see if it pays. If not, I will defer to your advice on closures.
 

Orthocoderpgu

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Thank you! I'm new to plastics so this is helpful. I rebilled without the 50 mod and will see if it pays. If not, I will defer to your advice on closures.
Again, I code orthopedic surgeries and this is not anything that I have ever dealt with before. I did some research on breast capsulotomy and from what I can tell the closure is going to be included with the surgical procedure. This does not seem to be a secondary closure, nor is there any tissue rearrangement. This just seems to be layered closure without tissue rearrangement. This closure seems to be part of the surgical procedure and I don't see anything that would allow it to be separately reported such as secondary closure, tissue rearrangement and so forth...
 
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