Wiki Coding Malignant lesion & Complex repair same day

[neha.bhatnagar]

Hi Friends,

Our physician has performed Excision of Malignant lesion CPT 11642 and Complex repair of same area CPT 13151 on same day.
As per the coding guidelines these codes can be coded/billed together without any modifier. But Medicare has denied this claim stating need appropriate modifier.
We have tried using 51 & 59 modifier but the claim was again denied stating need appropriate modifier.
Can anyone please help with this?

Thanks & Regards,
Neha Bhatnagar, CPC, CPC-H

 

[mitchellde]

They are probably wanting a 59 which is not appropriate. Prior to last year you could not code the excision with a complex repair and that was then changed. Your payer may not have changed the rule in their edits. You will need to make a copy of the description in the CPT book which details this and send it in with an appeal.

 

[ssmeyers48]

Did you bill those codes with any other codes? Could be why they are asking for a modifier. Or is it in a post-op period? If no to both then I agree with the post above.

 

[DONNA GRIMM]

Cpc, cpcd

I received a denial from Medicare for excision 11446 that was billed with complex repair 13132. I called the re-opening line at Medicare & was told that the 11446 lacked a "secondary diagnosis". I have no idea what that would be. The CPT book does not indicate that a secondary dx is needed when billing an excision with a complex closere. Anyone have an answer to this?

 

[FTessaBartels]

Open wound

I attended a seminar on coding sponsored by the American Academy of Plastic Surgeons. The suggestion was that the repair have a dx of "open wound."

Hope that helps.

F Tessa Bartels, CPC, CEMC