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Excision Medical billing Made Simple

Excision Medical billing Made Simple

Excision Medical billing Made Simple

Excision and Lesion medical billing can leave many doubts in your employees’ minds. There are so many gray areas that one can run into. There are several excision medical billing scenarios that can easily be cleared up with a simple explanation.

Simple Excision (with referral)
In medical billing, you will learn that many times services are included in the fees of another service. For example, if a general practice physician refers a patient to your surgeon’s office to check a mole, your surgeon might take one look at the mole and immediately remove it in the office. When it comes to the medical billing of this visit you might wonder if you should bill for the evaluation and management portion of the visit as well as excision. In this case, the answer is no. Every procedure done in the office includes an evaluation and management exam. It is not appropriate to do medical billing separately for this service unless you go above and beyond a minimal exam.

Unexpected Findings from a Referral
There are some situations in excision medical billing where your surgeon might see a patient and decide to operate at a later date. For instance, if a patient is referred to the surgeon’s office and your surgeon believes it may be more serious than originally thought to be, he/she might schedule a surgery for a later date. In this case, medical billing should reflect both the evaluation and management exam AND the surgery at a later date. Since there was a reason the surgery was not done on the date of the E/M, it can be claimed separately for medical billing purposes.

Multiple Excisions on One Lesion
There are times in lesion excisions when the entire lesion is not removed. If tests come back positive showing that the surgeon failed to remove the entire carcinoma, he/she must go back in and take additional tissue. When doing medical billing in this situation, you would use the CPT code 11601 for the initial excision. Then you would use the proper medical billing code that described the size of the second excision. Along with the second CPT code, you would want to use the medical billing modifier 58 (Staged or related procedure or service by the same physician during the postoperative period).

Excisions are not cut and dry. No procedure is cut and dry in medical billing. If you have a surgeon in your practice, be sure to keep current with excision medical billing procedures.

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