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Help Coding Excision Lesions with Layered closures

  1. #1
    Default Help Coding Excision Lesions with Layered closures
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    Just wondering if someone would be able to help out on this one. My doc performed Excison of 5 lesions of the back with layered closures I coded the following: 11401 ,and then 11400, 11400-59, 11400-59, 11400-59 and then my layered closure 12034 Insurance company is denying the layered closure due to CCI edits Just wondering what modifier to use the 59 (although its not really separate/distinct) or do I just go ahead and use the 58
    Thanks for any help - Still trying to figure all this out-Its only been 2 yrs and I code and bill for a general surgeon
    Deb, CPC

  2. #2
    Milwaukee WI
    Default Appeal with copy of CPC
    We've used both M51 and M59. It seems that no matter which modifier I use (or don't use) the closure gets denied.

    I appeal these denials with the copies of the guidelines direct from CPC ... underlining the direction to code intermediate or complex closure separately. And I also include a copy of the CCI edits, which clearly allows for the closure being separately reported.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    you should bill each excision with its own repair code, and no do not use mod 58
    example of using mod 58 is when doc puts a port in a pt for chemotherapy tx after surgery and its in a post op period.
    ex: 36561 58
    77001 26

    v58.11 174.9

    have a good one
    hope this helps

  4. Smile
    The intermediate repair code specifically states to add the sum of the length of repairs together if they are in the same location(the back) I would use one repair code with a 51 modifier.

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