Wiki Malignant Removal and layerd closure

[AthensCoder]

The doctor I bill for did a malignant removal of a lesion and did a layered lesion. The doctor is billing the following codes: 11603, 12032 -79

I do not belive that this is the correct modifier, can anyone help. I think maybe a modifier 22.

 

[jgf-CPC]

When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary proceure, using the 51 modifier.

 

[FTessaBartels]

Wrong modifier

I don't know why you would think to use a -22 modifier, unless the documentation showed an unusually difficult or complicated procedure. Please read CPT guidelines for Excision of Malignant Lesions (2009 CPT Professional edition, page 55, second column) The guidelines for removal of benign or malignant lesions specifically tell us to code a layered or complex closure separately.

Without seeing the operative report I cannot tell if the codes are correct, but they seem to be from the correct sections ... you have an excision code and a wound repair code.

The codes should be listed with highest RVU first, and the second code should have a -59 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC