Forum - Questions & Answers

Jul 9th, 2015 - cmgmr 4 

Coding excision closure

Our patient presented for excisional biopsy (11402) of a lesion on his back (238.2). The Physician closed the wound in 2 layers which indicates Intermediate Repair (12031). Again, much debate with the Biller who states "you cannot bill the 12031" and proceeded to submit the claim without the 12031.

Pathology indicated lesion was a Dermatofibroma, patient returned within the global period for suture removal.

Why would the closure not be billable?

Jul 9th, 2015 - petunia 195 

re: Coding excision closure

Here are the coding tips from Encoder Pro for CPT® code 11402 which clearly states you can bill a intermediate or a complex closure with 11402. You can not bill a simple closure as it would be included, but you may bill intermediate or complex.

Local anesthesia is included in these services. These procedures include simple (non-layered) closure. If intermediate (layered) or complex closure is necessary, see 12031-12037 or 13100-13122. For excision of a malignant lesion of the trunk, arms, or legs, see 11600-11606. For destruction of premalignant lesions, by any method, including laser, see 17000-17004; cutaneous vascular proliferative lesions, see 17106-17108; benign, report 17110-17111. For removal of skin tags, see 11200-11201. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Surgical trays, A4550, may be separately reimbursed by third-party payers. Check with the specific payer to determine coverage.

Code also:

Code also complex closure (13100-13153)

Code also each separate lesion

Code also intermediate closure (12031-12057)

Code also modifier 22 if excision is complicated or unusual

Code also reconstruction (15002-15261, 15570-15770)

Do not report with:

Do not report with adjacent tissue transfer (14000-14302)

Jul 9th, 2015 - cmgmr 4 

re: Coding excision closure

Thank you Petunia!

Jul 9th, 2015 - petunia 195 

re: Coding excision closure

you are most welcome. :)

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