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Coding question...

  1. Cool Coding question...
    Medical Coding Books
    The physician excises two benign lesions from a patient's back; one measuring 3.2 cm diameter and one measuring 2.4 cm excised diameter. Both areas of defect are closed with a simple closure. What would the correct code be?

    a. 11404, 11403-59
    b. 11406, 12002
    c. 11404, 11403-51
    d. 11404, 11403-59, 12002

    I believe it would be C, because it needs to have a modifier 51 appended to it, but i just want to make sure! Taking the exam on Saturday, and I'm picking at my brain as much as i can! Thanks for your help!!

  2. #2
    I work for an ASC and we don't use the 51 modifier...if it was a simple "non layered" closure I go with letter "a".

  3. #3
    I go woth answer "A"

  4. #4
    Columbia, MO
    If those are the only choices then it would be A. But if you are inclined to use the 51 then it would be appended as a second modifier after the 51. You need the 59 to identify the second procedure as a distinct and separate procedure and not bundled with the larger of the two, the 51 communicates that both were performed at the same session. I hope this helps you with the difference between the two

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Greeley, Colorado
    The answer would be A with modifier -59 because they are separate lesions.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Albany, New York
    I would say 11404 & 11403 (no modifer on either).
    The lesion size noted in each code description differentiates the two codes.
    Karen Maloney, CPC
    Data Quality Specialist

  7. #7
    Columbia, MO
    without the 59 modifier the smaller excision will bundle into the larger.

    Debra A. Mitchell, MSPH, CPC-H

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