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Reimbursement Advisor


2 procedures in 10 days will trigger bundling

November 2006 · Vol. 18, No. 11

<huc>Q</huc> Our patient is scheduled for a cesarean delivery, but the surgeon wants to excise a large keloid scar prior to the cesarean. How should this be coded?

<huc>A</huc> I am not sure by your question of the sequence or timing of events.

If the physician is taking the patient to surgery to do only the keloid excision, you have several codes to select from, depending on the type of closure. The excision of the keloid scar would be reported using 11400–11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs), where the code selected depends on the documented size of the scar removed.

If it is simple closure, no additional code is reported, but if the closure is either intermediate or complex, you will add a code from the repair section (12031–12037 or 13100–13102). But again the size in centimeters must be documented in order to use these codes.

Also remember that if the surgeon performs the cesarean within 10 days of the keloid excision, he/she will be in the global period for these codes and might have to use a modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) on the global OB code you report. If the keloid is excised at the time of the cesarean, it will be included by most payers as part of establishing the operative site and incision closure.

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