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Plastic surgery deniel

  1. #1
    Default Plastic surgery deniel
    Medical Coding Books
    Can anyone help with this. We got some denied procedures and I am new at plastic surgery. Here is how it was coded :


    The insurance denied the 13150 and the 13131 codes for incident to the primary procedure. Any help would be great and any reference material on this would be appreciated.


  2. #2
    Milwaukee WI
    Default Modifiers needed and Appeal
    Most of our payors want to see a -59 modifier on the repair code. This is especially important when you have multiple lesions and multiple procedures performed (you have a flap done in the same body area so they'd be wondering if the closure is related to that procedure). You need the -59 modifier to indicate that this was a separate incision (from the flap and from the other excisions).

    Even when using the -59 modifier, I see denials for the intermediate and complex closures resulting from excision of lesions all the time. I even have a "canned" appeal letter, they happen so frequently.

    Without seeing the actual op note, I can't really tell if these are legitimate codes in your case, but assuming that they are ...

    Appeal the denial, include a copy of the op note; clearly underline the areas that pertain to the closures that were denied; include a copy of CPT guidelines that clearly state that the intermediate or complex closure is to be separately reported. If you have pictures or diagrams that's even better.

    Hope that helps.

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 02-19-2009 at 10:38 AM.

  3. #3
    Thank you so much for all your help.


  4. Default help coding surgery
    investigate the possibility and appropriateness of using a 59 modifier

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