Benign Lesion Excision

[misbell]

Ok, I am obviously having a major brain meltdown this Monday morning.

Two benign lesions, eyelid, both eyes. Use one code (11440) and total up the sizes or you code both separately????

 

[TLC]

Benign Lesion

To my knowledge it should be 11440 (coding for the appropiate the size of lesion) twice with a modifer 59 to the second cpt code... "Adding codes" together would be for "laceration repairs" both of the same code category.

 

[mshay134]

To my knowledge it should be 11440 (coding for the appropiate the size of lesion) twice with a modifer 59 to the second cpt code... "Adding codes" together would be for "laceration repairs" both of the same code category.

I have to say that I agree with TLC regarding the 11440 code, but disagree with the modifier. 59 is for a staged procedure, whereas the more appropriate code would be 50 for bilateral procedure performed at the same session. Hope this helps

 

[mitchellde]

I have to say that I agree with TLC regarding the 11440 code, but disagree with the modifier. 59 is for a staged procedure, whereas the more appropriate code would be 50 for bilateral procedure performed at the same session. Hope this helps

59 is not for a staged procedure it is for a distinc and separate procedure and is appropriate for this scenario, 50 is incorrect as eyelids are not a paired organ. In fact there are 4 separate eyelids and are identified by modifiers E1-E4, however for lesion removal most payers will not accept these modifiers so we use the 59.

 

[FTessaBartels]

Code each lesion

You code each lesion separately. Codes in the integumentary section are not subject to the bilateral modifier (with the exception of those specifically involving breast surgery). The skin doesn't have laterality.

-59 would be the appropriate modifier to use to the second (and subsequent) lesion excision codes.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[armen]

CPT 11440 has a bilateral indicator "0", so you can not bill it with 50. See RVU file from CMS for reference. And to avoid a denial (in case payor does not want to see 59 on this cpt) just sent the claim with Op report atached. This will help.