July 25, 2019
I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the repair or is it included? My coder says it is billable with Modifier 59. Can you provide some guidance?
You are correct that you report CPT code 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm) for the excision. Yes you can report the repair based on CM size which would be coded with CPT code 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm). You would not append Modifier 59 since it is not a bundled service. The correct modifier to use is 51 and append it to the lesser RVU procedure which is the repair.
*This response is based on the best information available as of 07/25/19.