Wiki Seeking Help with Lesion Coding....

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karenmooneycpc

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:( Second Post.....I originally posted this question on 10/15 looking for some guidance hoping I would gain some assistance. I was having a mental block and really could not recall at the moment what I needed to do to code this correctly, integumentary is not my area I code regularly. I have been checking back with no luck. It has received over 100 reviews but not one tip on if this is correct or not. I will be honest when I say that I have never used this forum before an thought I would give it a try. I am looking for clarification and after 100 reviews, not even one person can jump out there and say yes, no, your way off base, I have no clue......I guess I should be glad it was not an urgent matter I was trying to confirm this information for.
Sincerely disheartened.
Karen Mooney

Modifier 51 with Excision of Lesions??
Need some clarification. I am drawing a complete blank and have already had a full pot of coffee which has not done the trick.

For some reason I cannot remember if I do or do not attach 51 modifier to the multiple lesion codes when reporting lesions. I know that the first code for each classification would be a stand alone (malignant, benign) but what about the following codes?

Example: 11624, 11404, 11403

I am wanting to report this as 11624, 11404, 11403-51

Would I only need the 51 modifier on the 11403 because it is within the same main code description as 11404? or do I need to attach the 51 modifier to the 11404 as well? My brain is just not firing this morning so any assistance that you could provide would be greatly appreciated. The paragraphical information in the CPT does not state, the descriptors do not state......
 
If a biospy is done you do need to code modifier 59/51 depending if it is not the primary code for example 12031 is primary so 11401 needs a -51 and the biospy can get a modifier.
hope that helps. So the guideline state if the biospy is performed on a separate lesion it is separately rpt with -59

s.b
 
The possible reason you received no replies is due the fact that you have no documentation to go by. Most of us are reluctant to give advice on codes given out of context as we can be providing incorrect advice depending on the scenario.
With the codes you have provided then I assume you have 3 separate excisions, no I would not use a 51 modifier on the 11403 as it will not prevent the payer from bundling it with the larger 11404. A 51 modifier only states that this was performed in the same session as the 11404 but does not state it was performed at a separate site. So the payer can deny this code saying it is at the same site as the larger 11404. A 59 modifier should be used if in fact you have 3 separate excision sites. The 59 modifier will communicate to the payer that the smaller excision is a completely different lesion.
I hope this will help
 
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The Coding Edge for October features modifier 50,51 and 59 on page 20 this might help you better understand how to use the these modifiers. Modifier 51 would indicate the same provider performed multiple procedures other than the E/M. The article also states you should list the most resource- intense( highest paying) procedure first and append modifier 51 to the second and the subsequent procedure. 11642, 11404-51, 11403-51.
I hope reading the article on modifier 51 and 59 will help you choose which one to use.
Fm
 
I disagree, if you are going to use the 51 modifier then use it after the 59. The 51 only says that multiple procedures were performed but not that different lesions were excised,
for example suppose the provider excised a small lesion and after excision examined the defect and decided a larger excision needed to be performed to obtain as much of the anomaly as possible. essentially 2 excisions were performed so you would then say OK bill both and use the 51, however since it was the same lesion excised as 2 procedures then you have only one lesion removed and can code only the larger code. But the payer would not know if this was the same or different lesion and will bundle the smaller code into the larger despite the 51 modifier. And they would be correct.
However if these were 2 separate lesions then with only the 51 modifier the payer will not recognize this and will bundle the smaller with the larger and they will be incorrect. Therefore with the 59 modifier attached to the smaller code this tells the payer that this was a distinct and separate procedure and they will not bundle and the reimbursement will be correct.
ALSO, many payers no longer use the 51 modifier so we generally do not use it unless a payer specifically directs us to.
 
TjH111964 said:
Lesion excisions are reported separately. So modifier 59 is not required. Modifier 51 would be used to indicate multiple procedures.
Click to expand...

The 59 IS required when the lesion are in the same body area but of the same or different size such as the 11404 and the 11403, the 51 modifier will not prevent the payer from bundling the 11403 as a part of the 11404. the 51 ONLY communicates that 2 excisions were performed in the same session, as I pointed out this could be either 2 separate lesions or the same lesion excised with 2 excisions one small and then a larger (this is frequently done) in the case of 2 separate lesions both are payable but without the 59 to indicate that these are distinct and separate procedures the payer will pay only one.
THE 51 modifier will NOT unbundle the procedures.
 
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