February 6, 2020
We have been billing malignant lesion excisions and ATT’s separately and we were getting paid. Now the payor is requesting a refund for the lesion excisions for these cases. Can we appeal this?
If a lesion is excised and an adjacent tissue transfer or rearrangement is performed at the same site, excision of the lesion is not reported separately. The CPT guidelines for this series of codes includes excision (including lesion) and/or repair by adjacent tissue transfer or rearrangement.
Please refer to CPT Assistant, July 1999.
*This response is based on the best information available as of 2/6/20.