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Wiki Use of Modifier 51 when coding lesion excision & repair

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dyoungberg

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When coding excision of a lesion with simple, intermediate or complex repair, where 2 codes are necessary, should modifier 51 be used on the repair code? Thanks!
 
Technically vs In Reality

Simple repair is INCLUDED in lesion excision, so should not be coded separately in any case (unless it's a totally different wound ... and you'd use a -59 modifier).

Technically you do not need ANY modifier as per CPT intermediate or complex repair is NOT included in the lesion excision. However, I find that using the -59 modifier is what most carriers want to see. Even then, we get denials, which we appeal with op note and a copy of the page from CPT.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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