Wiki Removal of benign lesion

[summerh75]

A patient was seen for removal of a benign skin lesion. I billed the insurance with CPT 11443 (excision benign skin lesion of face/ears/eyelids/nose/lips 2.1-3 cm). I received a denial stating a modifier is required for this code. I am unfamiliar with what modifier I am to use. I would really appreciate a little assistance if anyone can help with this.
Thank you in advance and God bless.

 

[thomas7331]

This code taken out of context, does not require a modifier, but there may be circumstances that would cause a modifier to be needed. For example, was this in the global period of a surgery, or was the patient enrolled in hospice, or were there other services done on the same day, or does the payer require modifiers for particular types of services or providers? It's hard to answer without more information, and if this is all they told you on the denial, the best bet is to try to get some clarification from the payer. I know that's easier said than done sometimes!

 

[summerh75]

Thank you for your response. No, it was not within a global period. The only thing that was done was the excision. This payer is part of Medi-cal (Medi-caid). They may have an issue I don't know about. I will have to call them and go from there. I do appreciate your help. God bless