Karin Posted Thu 22nd of March, 2012 03:31:50 AM
I need some reference to share with my physician as to why he can not bill both 11601/11621 Lesion Excision with Curretage and Destruction codes 17271/17261. There are only two lesions one on the hand and one on the wrist. He wants me to use Mod 59 on the 11601/11621. I don't think you can bill both removals as it is all the same site. How do you know if you should bill the excision versus the destruction. Again I need a reference to share....Thxs!
SuperCoder Answered Thu 22nd of March, 2012 12:23:09 PM
Yes, your physician is right. You may report both 11601 and 17261 (17261, 11601-59) if procedure is performed with two different incision or two different method on multiple lesion (even for same anatomical site).
CCI Edit allow modifier 59 with 11601.
But the expert advice is not to code these two codes together.
Reason: 11601 RVU is 6.67, 17261 RVU is 4.24.
As per CCI, CPT 11601 is column 2 code which mean modifier 59 should be appended to 11601.
So using -- 17261 – 4.24 , 11601-59 – 6.67/2 = 3.33
Billing these together will produce RVU 4.24+3.33 = 7.57 (Risk- there is a good chance of denial)
If you will report 11601 only then your RVU would be 6.67 and there will be no denial risk.
Karin Posted Thu 22nd of March, 2012 13:08:33 PM
OK - So you are saying that if the one CPT code has a higher RVU than the total of the codes billed you only bill the excision code that has the higher RVU...Right? The payor is Medicare. My billed codes would only be the 11601 and the 11621 - NO MODIFIER 59...Thanks!
SuperCoder Answered Thu 22nd of March, 2012 14:03:39 PM
Yes. You are right.
It's my pleasure to assist.