Francisco Posted Tue 16th of October, 2012 19:44:58 PM
We did outpatient surgery septo, smr '30520', and '3140'. Our dr. also repaired both lacerated earlobes at the same time '12011'. Insurance is denying earlobe repair as an integral part of the primary procedure '30520'. What does the earlobes have to do with the septal surgery? Can I also bill the '12011' as bilateral? Or should there be another code used for repair of lacerations to both earlobes? What is the proper coding to get paid for the repair of earlobes? I had previously used a 51 modifier on the '12011', which was still denied.
SuperCoder Answered Tue 16th of October, 2012 21:07:05 PM
To report repair of a torn ear lobe, we recommend 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).
This CPT code is used for the intermediate repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, which are 2.5 cm or less in size. The procedure involves the physician closing a wound to the ear with intermediate repairs or layered closure. It involves one or more of the deeper layers of subcutaneous tissue and superficial (nonmuscle) fascia, in addition to the skin (epidermal and dermal) closure.
If you have a larger tear than 2.5 cm, select the correct code within the 12051 to 12057 range by adding together the lengths of the wounds covered at each identical level to arrive at a total length. Then, select the corresponding code according to size.
Remember to use a separate Dx for earlobe repair and submit documentation to payor that 12011/12051 are separate/distinct from 30520
Since 12011/12051 has both ears,nose in their descriptors, the insurance in unable to distinguish between these two separate procedures.
12051/12011 are not billed bilateral.