Forum - Questions & Answers

Oct 3rd, 2012 - maria.rod333

intermediate repair code

I am coding excision of cyst (1 X 1 cm)breast, excision of lipoma (3X4cm) on arm, these are in the same anatomical loocation and repair code should be 1203?. WHat exactly does it mean to add up the lengths of the repairs? is it adding only the longest length of each excision? is it 1+4=5 12032 or 1X1= 1(breast repair) plus 3X4 = 12 (lipoma repair)= 13 total length? I am confused...so is the surgeon.
Thanks
Maria

Oct 3rd, 2012 - nmaguire   2,606 

re: intermediate repair code

The excision codes are coded for each lesion by diameter and margin of each.
The "simple" repair of lesion excisions are not separately coded.
If the repair required is intermediate or complex, it can be coded separately.
Billing for the excision of benign lesions with a lesion diameter of 0.5 cm or less (CPT®
11400, 11420, 11440) includes service for the simple, intermediate or complex repairs. In other words, separate billing for simple, intermediate, or complex repairs (CPT® 12001-12018) should not be reported with CPT® codes 11400, 11420 and 11440 when the diameter is 0.5 cm or less.
Billing for the excision of a benign lesionwith a lesion diameter greater than 0.5 cm or
the excision of malignant lesion of any size does not include the service for intermediate or medically necessary complex repairs CPT® codes 12031-12057. Separate billing for repair codes 13100-13152 may be reported with CPT® codes 11401–11406, 11421-11426, 11441-11446, and 11600-11646.
When coding an intermediate or complex repair, if there are multiple sites repaired in a CPT® descriptor and they are of same type, example "intermediate"--you add the length of each repair site and report one code for the total cm's.



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