CPCA Modifier Use in Dermatology 4 — Questions and Answers
Question 1: When a dermatologist performs a simple repair of a wound that is separate from an excision site during the same session, which scenario MOST accurately describes billing?
- The repair is always bundled with the excision
- Simple repairs are bundled into the excision code; only intermediate or complex repairs may be billed separately (Correct answer)
- Bill the repair with modifier 51 regardless of complexity
- Bill the repair with modifier 59
Correct answer: Simple repairs are bundled into the excision code; only intermediate or complex repairs may be billed separately
Per CPT bundling rules, simple (linear) closures are included in excision codes; intermediate or complex repairs at a different site may be billed separately.
Question 2: A patient has a staged excision: the first stage is performed today and the second stage is planned. Which modifier is used for the second stage?
- Modifier 78
- Modifier 79
- Modifier 58 (Correct answer)
- Modifier 76
Correct answer: Modifier 58
Modifier 58 indicates a staged or related procedure performed during the postoperative period of the initial procedure.
Question 3: Which of the following best describes the use of modifier 47 in dermatology?
- Anesthesia by the operating surgeon (Correct answer)
- Reduced services by the surgeon
- Bilateral procedure
- Unusual anesthesia
Correct answer: Anesthesia by the operating surgeon
Modifier 47 indicates that regional or general anesthesia was provided by the operating surgeon, not a separate anesthesiologist.
Question 4: A dermatopathologist performs a histologic examination of two separately submitted skin specimens from the same patient. How is this billed?
- Only one unit of the pathology code is billed
- Two units of the pathology code are billed with modifier 59 on the second
- Two units of the pathology code are billed without a modifier (Correct answer)
- Bill with modifier 51 on the second specimen
Correct answer: Two units of the pathology code are billed without a modifier
Each separately submitted specimen is billed as a separate unit of the pathology code; modifier 59 is not required when separate containers are submitted.
Question 5: Modifier 76 in dermatology is used when:
- A different physician repeats a procedure during the global period
- The same physician repeats the same procedure on the same day (Correct answer)
- A procedure is performed on the same lesion in a subsequent encounter
- A procedure is staged and planned
Correct answer: The same physician repeats the same procedure on the same day
Modifier 76 is appended when the same physician repeats the same procedure or service on the same date.
Question 6: A patient's excision of a malignant lesion requires significantly more time and complexity due to involvement of underlying fascia. Which modifier best captures this?
- Modifier 22 (Correct answer)
- Modifier 52
- Modifier 51
- Modifier 59
Correct answer: Modifier 22
Modifier 22 indicates increased procedural services when the work is substantially greater than typically required for the procedure.
Question 7: For Medicare patients, which modifier must be appended to an E/M code billed on the same day as a minor dermatological procedure to ensure separate payment?
- Modifier 59
- Modifier 51
- Modifier 25 (Correct answer)
- Modifier 24
Correct answer: Modifier 25
Modifier 25 must be appended to the E/M code to indicate it is a significant, separately identifiable service from a minor procedure performed on the same day.
CPCA Modifier Use in Dermatology 4
When a dermatologist performs a simple repair of a wound that is separate from an excision site during the same session, which scenario MOST accurately describes billing?