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Excision Coding - Intermediate Repair

  1. #1
    Default Excision Coding - Intermediate Repair
    Medical Coding Books
    Cpt Series (11402-11406), If A Intermediate Repair Is Done With This Procedure. Do You Append A Modifier. If So Which One. 59 Or 51.


    Respectfully
    Daniel, Cpc

  2. #2
    Default
    When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure using the -51 modifier.

    Hope this helps.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  3. #3
    Location
    Albany, New York
    Posts
    456
    Smile
    Code Range 11400-11406 includes "Simple" closure only.

    Intermediate and Complex closures in regards to this code range can be coded separately without a modifier.
    ****Reminder----if you have multiple lesion excisions within this code range (anatomical sites) and each requires an intermediate closure, you use the sum of all excision lengths to determine which closure code to assign.
    Karen Maloney, CPC
    Data Quality Specialist

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default We use a 59 modifier
    In our experience we get denials as "global" without the 59 modifier on the intermediate or complex closure (and sometimes we get denials WITH the modifier, but we appeal in any case).

    F Tessa Bartels, CPC, CPC-E/M

  5. Default
    Karen,

    Are you saying if the physician excises 4 lesions from this code range, each requiring intermediate closure, we would code the 4 excision codes but only one intermediate closure code? Wouldn't each excision be coded with its own closure code?

    N

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Add lengths for similar repairs
    Quote Originally Posted by ncantello View Post
    Karen,

    Are you saying if the physician excises 4 lesions from this code range, each requiring intermediate closure, we would code the 4 excision codes but only one intermediate closure code? Wouldn't each excision be coded with its own closure code?

    N
    Per CPT guidelines you ADD the lengths of all similar closures together to arrive at the code. In 2008 CPT Professional Edition, page 58, top of 2nd column, paragraph 2.
    When multiple wounds are repaired, add together the lengths of those in the same classification and from all anatomic sites that are grouped together into the same code description ...

    So if all four lesions are on the arm, and all four surgical wounds require intermediate closure, you'd add the lengths of these four wounds together to arrive at the single intermediate closure code (12031 - 12037)

    If three of the lesions were on the arm, and one was on the hand, but all were intermediate closures, then you add the 3 on the arm together for a 12031-12037 code; and you'd code the wound on the hand from the 12041-12047 section.

    Or, if three of the arm lesions required intermediate closure, but one required complex closure, you'd add the three intermediate lengths together (12031 - 12037), but code the complex closure separately (13120-13122).

    Hope I explained that well.

    F Tessa Bartles, CPC, CPC-E/M

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default BUT the LESIONS are separately coded
    But you code for EACH lesion EXCISION separately (unless you're talking skin tags)

    F Tessa Bartels, CPC, CPC-E/M

  8. Default Layered closures and lesions excisons
    Our doctors do not always use the word layered closure when when they remove lesions, but they often describe using two different suture materials, so I had assumed that it was a layered closure. The dictated report makes it sound as if it is more than one layer. I just read an article that said that it probably is a layered closure, but that you should ask every time and assume that their is a possibility that it is not a layered closure. Is that correct?

    Thanks,

    Dee

  9. #9
    Default
    there is also a great article on this in ED Coding Alert, so try looking it up online to see if you can access the archives. i believe it was in the February edition, or around that time.

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