April 17, 2014
We billed an excision of malignant lesion CPT code and an adjacent tissue transfer CPT code and only got paid for the lesion removal. How can we get paid for both services?
The excision of a skin lesion code (114xx, 116xx) is included in the adjacent tissue transfer codes (14000-14302) when performed on the same lesion/defect. Therefore, the malignant skin lesion excision should not have been billed. If you’ve “unbundled” the codes by billing both the lesion removal and adjacent tissue transfer then you should refile a corrected claim billing only the adjacent tissue transfer code. However, if the lesion was at a separate site from the adjacent tissue transfer and the two procedures were in no way related to each other, then you should have been paid for both. You should refile a corrected claim with modifier 59 (distinct procedural service) on the lesion removal code to show the lesion was distinctly separate from the adjacent tissue transfer service.