Wiki Help Coding Excision Lesions with Layered closures

[Hopp]

Just wondering if someone would be able to help out on this one. My doc performed Excison of 5 lesions of the back with layered closures I coded the following: 11401 ,and then 11400, 11400-59, 11400-59, 11400-59 and then my layered closure 12034 Insurance company is denying the layered closure due to CCI edits Just wondering what modifier to use the 59 (although its not really separate/distinct) or do I just go ahead and use the 58
Thanks for any help - Still trying to figure all this out-Its only been 2 yrs and I code and bill for a general surgeon
Deb, CPC

 

[FTessaBartels]

Appeal with copy of CPC

We've used both M51 and M59. It seems that no matter which modifier I use (or don't use) the closure gets denied.

I appeal these denials with the copies of the guidelines direct from CPC ... underlining the direction to code intermediate or complex closure separately. And I also include a copy of the CCI edits, which clearly allows for the closure being separately reported.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[marsha.russell]

you should bill each excision with its own repair code, and no do not use mod 58
example of using mod 58 is when doc puts a port in a pt for chemotherapy tx after surgery and its in a post op period.
ex: 36561 58
77001 26

v58.11 174.9

have a good one
hope this helps

 

[Cyndy]

The intermediate repair code specifically states to add the sum of the length of repairs together if they are in the same location(the back) I would use one repair code with a 51 modifier.