Using Modifier 51 With Lesion Removal

Lesion removals can be complex to report, however if you just break down the medical billing claim, you’ll find getting your filing points just right is a breeze.

Your claim will usually start in the emergency room and remember that in almost all cases, the excision site before sending the patient home. If this closure represents a simple repair, the work involved is bundled into the lesion excision code you report on the claim.

The other side of that type of claim however can be if the repair of the excision site gets more complicated, you’ll be able to report the closure as a separate procedure from the excision procedure.

The code that you’ll want to use when the ED physician performs an intermediate closure, will come from the 12031-12057 set. If you have a more complex closure, you will need to choose the correct code from the 13100-13153 set to explain the procedure done.

Complex or intermediate repair will often be a common occurrence in the ED and it’s not uncommon for the physician to perform a deep cut to excise a wound or cyst.

An example of a claim that might be submitted for a patient that presents with a wound of the scalp that requires excising would be :

* report 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm) for the lesion excision.

* report 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) for the excision site closure.

* attach modifier 51 (Multiple procedures) to 12032 to show that the site closure and the excision involved multiple procedures.

Use these tips and get your medical billing for lesion removal right every time!

View all Articles by: Kathryn Etienne, CCS-P