Wiki Multiple Procedures

[nicoleysmith]

Patient presents for neoplasm of uncertain behavior x3 left lateral and medial canthi and upper eyelid.

left lateral canthus: 2.5mm x 2.0 mm, intermediate repair

left medial canthus: 2.0 mm, intermediate repair

upper left eyelid margin punctured w/ sharp and drained of fluid

2 biopsies sent out.

I billed the following:
11440, D48.5
12051-59, D48.5
11440-59, D48.5
12051-59, D48.5

I'm new to coding derm, and am unsure if this is correct. Should I use modifier -51 or XS instead? Any help would be appreciated. Please and thank you!

 

[thomas7331]

Assuming that these are excisions, and that your pathology is benign, then the two 11440 codes and modifiers are OK. But per CPT, you can't bill two closures for the same code group - you have to add together all of the measurements of the closures in the group and charge a single code. However, you don't have the length of the closures documented here (the lesions size is not the same as the closure length), so you'll need to query the physician to document that. Intermediate closures don't bundle into excisions, so no modifier is necessary.

The diagnosis code D48.5 should only be used if the path report comes back indeterminate. Otherwise your diagnosis should reflect what the pathology report states.

 

[nicoleysmith]

Thank you so much! I will query the provider for the size of the closures and wait on the pathology report.