Wiki Keloid Excision and Injection with Kenalog

[jleavit2]

The NCCI policy manual says, "It is a misuse of CPT codes 11900, 11901, 96405, or 96406 to report injection of local anesthetic prior to another procedure on the lesion(s). Some of the procedures with which CPT codes 11900, 11901, 96405, and 96406 are not separately reportable if the intralesional injection is a local anesthetic include:" - Then it lists several derm procedures.

Is the CCI edit only for injection of a local anasthetic? Here's 2 questions:
1) If dr excise a keloid (114xx) and then inject with kenalog (11900) should we bill both procedures with modifier 59?
2) If dr cryo a wart (17110) and then inject the same wart with Candida (11900) should we bill both procedures with modifier 59?

I was under the impression that we bill only the most definitive procedure for each lesion but the CCI only appears to be in place to prevent billing the injection of local anesthetic separately. Does anyone have a source that says only bill the most definitive procedure for each lesion?

 

[ellzeycoding]

The carriers will not pay you to both excise or destroy a lesion AND to inject it. I understand the intent, but these are bundled according to the NCCI, and unless they are for separate and unrelated lesions, you cannot bill for both procedures on a single lesion.

 

[jleavit2]

That is our philosophy as well, which is why I thought it strange that the NCCI policy manual gives the impression that the CCI edit is in place only to prevent billing 11900 for local anesthetic injected with the listed derm procedures.

 

[ellzeycoding]

Local anesthesia is included in most surgical procedures and cannot be billed separately using a 11900 code. That's all it is saying.

But 11900 can be used for other types of injectable services, like injecting kenalog into an acne cyst to dry it up. Or into an existing scar to reduce inflammation. In this case it can be billed. But you could not both destroy a lesion (it's gone) and then inject the same now non-existent lesion with kenalog.