information Please


Murfreesboro, TN
Best answers
We have a new Plastic surgeon on staff and are wondering if it is correct to code 11622 and 11624 with the adjacent tissue transfer code 14060. I have looked in the National Correct Coding Sourcebook and it does show they are bundled but you can use the 59 modifier if the documentation is in order. The doctor is very concerned and wants to make sure we are billing correctly. Any help will be greatly appreciated.

I would code only the 14060. I have the CPC Expert book and it indicates that the range of code from 14000-14350 "INCLUDES the excision of lesion with repair by adjacent tissue transfer or tissue rearrangement, Z-plasty, W-plasty, VY-plasty, rotation flap, advancement flap, double pedicle flap"

I hope this helps....!!!;)
One lesion or multiple lesions?

The scenario in which you can use the 59 modifier is when you have multiple lesions ... and one requires the flap (CPT 14000-14350), while another separate lesion can be handled using CPT 11400-11646 (depending on whether benign or malignant). AND for the additional lesion(s) you may also bill CPT 12031-13153 for intermediate or complex repair, if so documented.

I have had success in these scenarios but almost always after an initial denial and then an appeal with documentation AND photos to clearly show the separate lesions.

F Tessa Bartels, CPC