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Thread: need help - Our doctor did an excision

  1. #1
    Join Date
    Apr 2007
    Las Vegas

    Unhappy need help - Our doctor did an excision

    AAPC: Back to School
    Our doctor did an excision of lesions on a patient & he also did a biopsy of a lesion on the right & the left leg. The CPT we used was 11100, 11101 & 11400-59. Medicare only paid 11101 & 11400-59 but did not pay on 11000 saying "not covered when performed during the same session/date as a previously processed service for the patient". What was wrong with it? there were two different lesions, different site, that's why we used 11100 for the first lesion & 11101 (add=on code) for the second lesion. I know we are not supposed to use modifier on 11101 because it is an add-on code. Do I need to appeal this with a modifier? Any help/suggestion will be greatly appreciated? Thank you
    Last edited by ank3t; 10-20-2016 at 05:15 AM.

  2. #2
    Join Date
    Apr 2007
    Portland, Oregon

    Smile biopsy and excision

    -The rule for the 11100-11101 biopsy CPT code: You cannot code a biopsy and removal in the same day, only on different days. Also, no modifier is necessary if the biopsy and excision are performed on separate days.
    -With 11400-11471(benign) and 11600-11646 (malignant) excision CPT codes (require size, location):I think you use modifier-59 is OK.
    -Select a CPT code only after the pathology report has returned as malignant lesions require different codes and reimburse at a much higher rate.
    I hope it can help.

    Good luck

    Jeslyn Nam CPC-A

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Two lesions or Three Lesions?

    Were there two lesions or three lesions?

    If you have three separate lesions, then I would appeal with the op note and a letter clearly outlining that there were three distinct sites.

    If you have only two lesions and the excision was done after the biopsy, then the denial is correct.

    F Tessa Bartels, CPC, CEMC

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