August 18, 2016
Patient comes in for what they are calling scar revision and the note states that “standing cutaneous excess of the left abdominal scar” was sharply excised. We are billing with a diagnosis of hypertrophic scar (L91.0) and CPT codes of 11406 (excision of benign lesion) and 12034 (intermediate repair) for the procedure. On speaking with a co-worker regarding the note, since I’m new to plastics surgery, we are wondering if we should bill 15830 with 52 modifier because it appears to me that the excess skin is being removed. What do you think?
CPT says for scar revision to use a complex repair code such as 13100–13102. Do not use the benign lesion removal and intermediate repair code combination (11404 and 12034). Also, do not use 15830 – that code says Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy. CPT 15830 is meant for procedures commonly referred to as a panniculectomy to prevent the occurrence of recurring rashes, skin maceration, and yeast infections that develop in the abdominopelvic fold following extreme weight loss – not for scar revision.
*This response is based on the best information available as of 08/18/16.