October 20, 2022
My provider excised an epidermal cyst on the patient’s neck with a defect of 1.2cm. She also reported that she did an intermediate layered closure of the same size. I reported codes 11422 for the excision and 12041 for the suture repair. A modifier 59 was appended to code 12041 but the payer is denying it stating the modifier is inappropriate. I resubmitted the claim removing modifier 59 to the procedure 11422 but it denied for the same reason. Should I be using modifier 51 instead of 59?
The excision 11422 and intermediate repair 12041 are not bundled under the National Correct Coding Initiative (NCCI). You should not report these two services with Modifier 59. You should report the repair with Modifier 51.
*This response is based on the best information available as of 10/20/22.