tci Part B Insider - 2012 Issue 45

Reader Question: Add Sizes or Lesions?

Question: When our surgeon excises multiple lesions, I’ve heard that we should we add the sizes together and bill for one excision. Is that correct? Answer: No, that is not correct, although it is a "common misconception," according to CPT® Assistant. Do this: You should separately bill for each lesion using modifier 59 (Distinct procedural service) or perhaps multiple units of service, depending on payer instruction. The only exception is if the surgeon excises two lesions close together, using only one excision. Source of confusion: Coders may be mixing up lesion excision rules with the rules for...

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