Can you please give me your opinion on a coding case?
We have a surgical oncologist that performed an excision of malignant skin lesions on the face, using code 11621. A plastic surgeon (in the OR at the same time) performs immediate reconstructive closure. It was an intermediate repair using 12051.
It is my feeling that the excision of the malignant lesion should be billed with modifier 52 for reduced services since the closure is performed by the plastic surgeon. I have been researching this and I am unable to find any official guidance. I did submit 1 claim with modifier 52 to Medicare but the claim was denied.
What do you think?
According to CPT®, only simple repair is included in lesion excision codes. Each service may be billed by the individual surgeon without a modifier.become a member. Already a member? Login