Q & A: Coding for cysts

April 1, 2008

The physician removed a cyst from the patient's right upper back. The cyst measured 5.0 centimeters in diameter, but it was removed through a 0.9 x 3.1 cm/d opening. I billed the excision based on the 5.0 centimeter size. Is that correct? - Looking for an Opening

Key Points

Q: The physician removed a cyst from the patient's right upper back. The cyst measured 5.0 centimeters in diameter, but it was removed through a 0.9 x 3.1 cm/d opening. I billed the excision based on the 5.0 centimeter size. Is that correct? -Looking for an Opening

A: Dear Looking: You are correct! You can use the size of the lesion based on its largest dimension, whether that is the length, width or depth. For excisions you can add the conservative margins that you must take to remove the lesion. However, in the case of a cyst, the dermatologist doesn't have margins. The cyst is carefully removed (pulled out and then released from the skin) through an incision that is usually smaller than the size of the lesion. Keep in mind that you can bill the repair (e.g., intermediate) based on the length of the defect (which in your example is 3.1 centimeters long).

Q: My provider performed the following four procedures during a postoperative period. I placed modifier 79 on the two excisions. Do I also need to put the postoperative modifier on the repairs? We billed as follows:11441 -79 11403 -79 12031 12041

A: Dear Need: Any time you are in a postoperative period, all services and all E/M visits need to have the appropriate postoperative modifiers. Use modifier 79 for surgical services and modifier 24 for E/M visits. Laboratory services (e.g., CPT codes that start with an "8") do not need any modifiers, as these codes are not edited by postoperative edits.

So, in your example, you must use modifier 79 on all four codes. In addition, you need to check the Bundling Tables (e.g., Correct Coding Initiative) to see if you have any bundled services. In your example, you will see that you must add modifier 59 to CPT code 12041 since it appears as a bundled pair with CPT code 12031. So, the correct way to bill your claim is as follows:
11441 -79
11403 -79
12031 -79
12041 -79 -59

Note: The postoperative modifier always comes before the bundling modifier.