The doctor I work with excised two benign lesions from a patient’s arm, of the same length. Do I add them together and report one code? Each was .5 cm. Do I report 11400 twice or 11401 once?
Report 11400 twice. Laceration repairs of the same depth and location are added together, but lesions are reported for each lesion, based on the length of the excision. You will need a modifier on the second lesion to tell the payer you aren’t submitting a duplicate charge.
Some payers will want modifier 59 on the second code (no modifier on the first) to indicate that it was a distinct procedural service.
Some payers will accept modifier 76 – repeat procedure or service by the same physician. The CPT® definition of modifier 76 continues, “was repeated by the same physician…subsequent to the original procedure or service.” I prefer modifier 59 but some payers may require modifier 76.
Reviewed, Betsy Nicoletti 10/12/2018To access our entire premium content library of articles, billing guides, quick reference sheets and more, become a member. Already a member? Login