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Lesion removal

  1. Smile
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    You are all confusing me! The fact that he did an intermediate closure tells me that this lesion went deeper than just the skin

    code 11046 is for removal of a lesion over 4.0 cm of the dermis only

    the first thing i would do is query the doctor and determine how deep he had to excise the lesion dermis, subcutaneous, subfascial etc....

    If it stayed in the just the dermis then 11406 is correct and the intermediate closure is separately payable per the cpt book notations under benign lesions, but you will have to check with your lcd's for your area in order to determine if diagnosis code is correct. Also did you bill what diagnosis the pathology report gave?

  2. #12
    Columbia, MO
    Quote Originally Posted by paula f3 View Post
    I am really perplexed with this one. Physican removed a benign lesion (8cm,thigh) w intermediate closure. I coded 11406, 12032. DX 216.7. Medicare pd the closure but not the excision due to medical necessity. We did a phone reopening added Dx code V49.89 and have still reced a denial. Called the surgeon office and they are telling me they used the same codes, sequencing different 12032, 11406-59. In cking my Medicare CCI edits neither of the 2 codes a bundles, BUT they got pd for both codes. Please explain so that I can understand .

    I think the previous post meant 11406 which is an excision code which is full thickness meaning thru the dermis into the subq tissue. So the intermediate closure is appropriate. I do not understand the rationale for the V49.89 it is code for other factors influencing health status and does not provide rationale for the closure. I also agree that you do not need the 59 modifier. It has always been a rule that an intermediate closure is separately payable. I would resubmit with the documentation and the instructions from the CPT book that state to code the closure in addition.

    Debra A. Mitchell, MSPH, CPC-H

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