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
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