Can you code 25111, excision of ganglion cyst, more than once?

TPeniston61

Networker
Messages
52
Location
Carlsbad, California
Best answers
0
Our hand specialist performed an excision of ganglion cysts on one wrist, both volar and dorsal. CPT code 25111 is excision of ganglion cyst, dorsal or volar. If the surgeon did two separate incisions, can he bill 25111 twice? All the edits say that you can only bill it once, but how do you bill to indicate that you did more than one cyst. The problem is that there are no codes that distinguish between dorsal and volar cyst, so you would be using the same diagnosis, M67.341. Does anyone have any other suggestions on how to bill this? It would be helpful to know since this procedure seems to be common. Thank you.
 

Orthocoderpgu

True Blue
Messages
1,715
Location
Salt Lake City, UT
Best answers
9
I have coded for hand surgeons for eight years and have never seen this. The MUE on 25111 is a policy edit, so you can't bill it more than once. But you can bill it with a -22. Your only option right now.
 

klienhart

Networker
Messages
40
Best answers
0
Hi, I do hand surgery coding, and while I have not seen this situation before, I do have thoughts on this. MUE are usually related to Medicare. Some commercial payors might reimburse for both excisions. I would bill 25111 x 2. If you receive a denial, appeal with the operative report.
 

kimberlywatson

Networker
Messages
70
Location
Brentwood, TN
Best answers
0
Similar to klienhart's answer above, you could also try billing it on separate lines with an XS or 59 modifier. It's possible to override an MUE with proper documentation but yes you might have to appeal a denial.
 
Top