Question: Our dermatologist shaved three epidermal lesions that the patient chose not to have submitted to pathology: a 0.4 cm lesion from the patient’s chest, a 0.3 lesion from the patient’s back, and a 0.2 lesion from the patient’s stomach. Will I need to include modifiers?
Answer: Because CPT classifies the shaves with the same anatomic area and size code, you will need a modifier on the second and third shave removal codes. Without the modifiers, the insurer’s software system may throw out the additional shaves as duplicates.
You should technically use modifier 51 (Multiple procedures) on the second shave (11300, Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less). Then separate the third excision from the second with modifier 59 (Distinct procedural service). The claim would contain: 11300, 11300-51, and 11300-59.
If you’re reporting the claim to a Medicare carrier, omit modifier 51. Medicare’s computer editing system automatically considers eligible additional procedures multiple without requiring modifier 51. Because of this, Medicare would deny your line item of 13000-51. You could append modifier 59 (Distinct procedural service) instead: 13000, 13000-59, and 13000-59.
Report multiple excisions and repairs with ease. An audio training event with Betty Johnson.
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