Coding and Compliance: Use Correct Modifiers for Cleaner Lesion Excision Coding Claims



If you want to have cleaner lesion excision coding claims, it is essential that you use your modifiers correctly. Looking at the CPT guidelines should be one of the places we will always go, of course, reviewing the payer medical coding guidelines because every one doesn't accept every modifier.

And even if they do accept them, they might accept them in a little bit different of a context than what CPT does. So, you will always want to go to your payers and see how they look at or how they accept those modifiers.

And then if it's modifiers that kind of perk up years like modifier -25, modifier -59 -- those are two modifiers that due to OIG reports that have taken a look at our use of them. We have shown to not use them very appropriately all the time. So, those modifiers tend to get looked at sometimes. So you want to also take a look at some of your medical coding notes.

And we are not saying every single note that goes out the door but take a look and spot check some of these where you're using some of the modifiers to make sure the documentation is going to hold up if it gets asked for.

And then of course, we can ask only use the two-digit modifiers now. We can't make the long modifiers like we used to. We can't make the five-digit modifiers. And then take a look at the NCCI, the edits for bundling that are out there to make sure that we can append the modifier to what we are coding or if it would be considered unbundling if we try to bill a couple of things together.

The modifiers that we probably are mostly going to use are going to be the -51 and the -59 as per the medical coding rules. And when you're doing stages of stuff, if you're physician is excising and then doing closures or you're doing the modes and then they're coming to do closures later, you may need to also use modifier -58 a lot because you're in the global period and you want to show or state what's being done.

So, with modifier -59, just check that and make sure you're looking at the NCCI edits to make sure that it's appropriate to bypass the edit with the modifier, and to look in the back of your CPT book. If you look in Appendix A in the back of a CPT manual, it will give you some kind of pointers about the fact that the documentation must support and then it gives you a listing -- it's a session different, a different procedure, a different surgery, a different site, a different organ system, separate incision or excision, separate lesion or separate injury.

So just make sure that modifier -59 is the modifier is the modifier you want and not -51. Usually if you're looking for -59 it's because of an NCCI edit. So, just be judicious with your application of modifiers for accurate lesion excision medical coding. But if you need it to get paid and it's appropriate, never be afraid to put one of those modifiers on your claim form.

To get more medical coding updates and training, go to our CPT medical coding training online page.

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