These codes are bundled but a 59 can be used to unbundle them. I code for some plastic surgeons that go in and take out excess atrophic skin before general surgeons come in to remove a hernia. Then the plastics guys go back in to close the flaps. I don't really think this scenerio would call for the 59. But when would you use these 2 codes together? On the majority of these cases this particular physician wants to bill these codes together.