“I have a simple question for which I have not been able to find the correct answer. I have a Medicare patient whom we took to the operating room to remove 3 skin lesions. Two were removed from the left foot and one was removed from the right foot. We used code CPT 11421 and are planning on billing the following way:
CPT 11421 – 50 (2 units, one lesion on the LT and one the RT)
CPT 11421 – LT (the other lesion on the LT)
I checked CCI edits and it says I do not need to use a 59 modifier but I feel like I should. Some people have said to use XS modifier. Some have said to bill one code 3 units and others to bill 11421 3 times. What’s the correct answer?”
The 1142_ CPT code set is specific for the excision of benign lesions from the extremities. With respect to the excision of benign lesions from the feet, there is a code set that is based upon the excised diameter of the lesion.
CPT 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter 0.5cm or less
CPT 11421 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter 0.6 to 1.0 cm
CPT 11422 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter 1.1 to 2.0 cm
CPT 11423 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter 2.1 to 3.0 cm
CPT 11424 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter 3.1 to 4.0 cm
CPT 11426 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), feet; excised diameter over 4.0 cm
These CPT codes are billed per specific lesion that is excised, not based upon the total number of lesions of a certain size range that is identified by a CPT code.
In the above question, 3 lesions were excised from the patient’s feet, two from the left foot and one from the right foot. The 1142_ code set does not support the appending of the 50 modifier that identifies bilateral surgery. The 50 modifier is identified as: BILATERAL PROCEDURE – Use when the second procedure is identical to the first and performed on the opposite limb part. Unless the 2 lesions that are excised are exactly the same and are excised from exactly the same location on both feet, the use of the 50 modifier is moot.
Billing CPT code 1142_ at the number of units that the specific CPT code was performed on the patient on a given date of service, in this situation, CPT code 11421, is not specific enough and does not reflect with as much specificity as possible, where anatomically the 3 excisions were performed.
Therefore, I feel that it is most appropriate to bill each of the excisions that were performed on the patient’s feet on a separate line appended by the appropriate anatomical modifier(s) to demonstrate where each individual procedure was performed. If the procedure was performed on a toe, the correct toe modifier would be appended. If the procedure was performed on the foot, but not on a toe, then the correct lower extremity/side of the body modifier would be appended.
Two lesions were excised from the left foot and one lesion was excised from the right foot. The correct coding scenario would be the following:
CPT 11421 – RT
CPT 11421 – LT
CPT 11421 – 59, LT or CPT 11421 – XS, LT. The 59 modifier identifies a Distinct Procedural Service. The XS modifier identifies a Separate Structure: A service that is distinct because it was performed on a separate organ or structure.
What about the ICD-10-CM codes to bill? Ideally it would be best to wait until the pathology report is obtained in order to bill with as much specificity as possible. However, if the provider does not want to wait until the pathology report arrives, here are the most appropriate CPT codes to link to the CPT codes that were billed:
D23.71 Other benign neoplasm of right lower limb, including hip
D23.72 Other benign neoplasm of left lower limb, including hip
This is my opinion.
Michael G. Warshaw
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