Francisco Posted Tue 20th of November, 2012 18:29:30 PM
Outpatient surgery with multiple skin lesion removals from face, nose and scalp. Two '11643' lesions required STSG '15120'. Insurance denied payment on second '15120' saying there is an add-on code available for more than 100 sq cm. Since these are separate sites, each less than 100 sq cm, should there be a different code used for the second STSG? I did use '51' modifier on the second '15120' procedure. Could you help me with proper coding, or is the insurance company correct that they will not pay for a second graft? Insurance paid for all four lesion removals, but only one of the two '15120' charges.
SuperCoder Answered Tue 20th of November, 2012 21:20:38 PM
No. Codes 15100-15157 are calculated by total repair of the site(s) and reported on the basis of the size and location of the recipient area. If 100 sq cm or less of split grafting is provided for any variation of the trunk, arms, or legs, code 15100, Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050), should be reported once to identify the total repair of the site(s) provided.
If the size is less than 100 sq cm for both lesions, adding up makes them greater than 100, use primary 15120 as well as the add on code to represent.