I know the answers I read from you on the AAPC site were from 2015, but I need to rebill a 15823 mod 50 with a lesion removal 11440. I originally billed with a 51 mod and it was denied. What should I have done as Medicare naturally paid the lesser and denied the bleph as inclusive.
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Tag Archives: Lesion
Help With Coding Exc of Skin lesion with Full Thickness skin graft & Layered closure
Hi everyone! Just wondering if its appropriate to use the following codes:
Excision of 3 Cm Leison Squamous cell ca of lt hand CPT 11623
with 8 cm layered closure CPT 12044 with 59
and Full Thickness skin graft 15240 (or does the skin graft cover the closure as well)
Thanks in advance for any help with theis matter. DH, CPC
Excision of 3 Cm Leison Squamous cell ca of lt hand CPT 11623
with 8 cm layered closure CPT 12044 with 59
and Full Thickness skin graft 15240 (or does the skin graft cover the closure as well)
Thanks in advance for any help with theis matter. DH, CPC
Novitas Solutions JL bundling of benign lesion of .5cm or less with closure
Medicare is bundling excision of benign lesion .5cm or less with intermediate closure.
Based on the CPT manual instructions that intermediate and complex closures should be reported separately, my physician wants to add a 59 modifier to the closure.
It is my understanding that Medicare considers simple, intermediate and complex closure inclusive when the removal of the benign lesion is .5cm or less.
The codes are NCCI edits and can be overridden by adding modifier 59 to the repair. Since the repair is not a separate encounter, separate structure, separate practitioner or unusual non-overlapping service, would modifier 59 really apply?
CPT’s 11440
CPT’s 12011, 12051, 13151
Please advise.
Thanks,
Camille Waterhouse, CPC
Noridian – Benign Lesion Removal LCD
Coding medical necessity for benign skin lesions for Medicare. LCD L34233 (Noridian) Group 2 – List III codes
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain
When a dysplastic nevus with moderate atypia is removed via excision, wondering what would be most appropiate code if any from group III when no symptoms are present. Thoughts?
Unsuccessful Attempts at Crossing Lesion
I have a procedure report I am trying to code and I am not sure of the guidelines when the provider has unsuccessful attempts at crossing the lesion. I would like to code for the work for attempting to cross the lesion, but am unsure if this is appropriate or not. Here is the documentation:
"Patient was given 5000 and then +1000 6000 total of IV heparin, with the sheath in the proximal superficial femoral artery on the left side and the pigtail catheter and the descending aorta I tried to pass the wire it looks like with adjacent shaft forming of the wire it was going somewhere into the iliac artery. It was exchanged with the woolly wire however it did not cross into the aorta somewhere it appears to be subintimal. Then I exchanged the pigtail catheter was 7 French 90 cm pedicle from the brachial artery to the descending aorta and tried to pass antegrade and it is again not crossing into the channel. After trying for almost an hour and half I decided to stop it. Noted this time compared to the initial picture and there is some filling of the external iliac artery was noted there was now dye extravasation was seen. I decided to stop the procedure and plan to bring him back to reevaluate him in 2 weeks weeks"
Measuring and coding malignant and benign lesion
Fellow coders can you please let me know with examples different ways of measuring lesions!!
Thank You
Kalpana
Thank You
Kalpana
Post Op Malignant lesion f/u surveillance Box A MDM
3 bcc a are destructed. Patient comes in for follow up surveillance of skin cancer return. There is no recurrence. Would this count as 3 established or improved on number of diagnoses treated?
lesion removal documentation
Medicare requested prepayment documentation for lesion removal. (11642 11422 & 11441) I sent they operative report which showed lesion size in the heading of the op report.
Procedures:
1. Excision of left brow carcinoma in situ (1.5 cm)
2. Left lateral canthus skin lesion excision (0.6 cm)
3. Right oral commissure area skin lesion excision (1 cm)
4. Excision of scalp lesion (2 cm)
They denied stating documentation lacks the margin size of the lesions. I have searched high and low and cannot find anywhere that it states they have to specifically state margin size. Or even specific guidelines on what needs to be in medical record for lesion removal. Can anyone point me in the right direction. It is NGS Medicare Part B.
Thank you in advance.
Pre Ulcertive Lesion
Help… Looking for the Dx code for a Pre Ulcerative Lesion. L84 was mentioned, but is this the best option. My provider uses this Dx a lot w/ or w/o DM. I don’t think L84 applicable..
Thanks in advance..
knee OCD lesion repair
The patient has an OCD lesion on the femoral condyle. The provider did arthroscopic debridement of it followed by open repair with screws (no grafts). The CPT description of 29885 doesn’t indicate that it would be arthroscopically aided, so I don’t believe I can use it to encompass the whole procedure. However I don’t see an open code. Is there something I’m missing, or do I need to code it as unlisted and compare to 29885?
Thanks!
Susan