CPCA Modifier Use in Dermatology 2 — Questions and Answers
Question 1: A dermatologist performs a shave removal of a benign lesion on the back and, during the same session, destroys a premalignant actinic keratosis on the forearm. Which modifier is appended to the destruction code?
- Modifier 51 (Correct answer)
- Modifier 59
- Modifier 25
- Modifier 79
Correct answer: Modifier 51
Modifier 51 is used when multiple procedures are performed during the same operative session by the same physician.
Question 2: When a physician performs a biopsy and then a more definitive excision of the same lesion during the same encounter, which modifier allows separate billing for the biopsy?
- Modifier 58
- Modifier 59 (Correct answer)
- Modifier 79
- Modifier 78
Correct answer: Modifier 59
Modifier 59 indicates a distinct procedural service, allowing the biopsy to be billed separately from the excision performed at the same encounter.
Question 3: A patient has a malignant melanoma excised with a 2 cm margin from the right cheek. The surgeon also excises a basal cell carcinoma from the left cheek during the same session. What modifier is added to the second excision code?
- Modifier 50
- Modifier 51 (Correct answer)
- Modifier 25
- Modifier RT/LT
Correct answer: Modifier 51
Modifier 51 is appended to the secondary procedure to indicate multiple procedures were performed at the same session.
Question 4: Modifier 52 is used in dermatology coding when:
- A procedure is performed bilaterally
- A procedure is performed at a reduced level of service (Correct answer)
- An unplanned return to the OR occurs
- A staged procedure is planned
Correct answer: A procedure is performed at a reduced level of service
Modifier 52 indicates that a service or procedure was partially reduced or eliminated at the physician's discretion.
Question 5: A dermatologist excises a squamous cell carcinoma from the scalp and repairs the wound with an adjacent tissue transfer. How should the repair be billed?
- It is bundled into the excision code
- Bill separately with modifier 51
- Bill separately without a modifier (Correct answer)
- Bill separately with modifier 59
Correct answer: Bill separately without a modifier
Adjacent tissue transfer or rearrangement repairs are separately billable from excision codes without an additional modifier because they are not considered bundled services.
Question 6: Which modifier would be appended to indicate that a procedure performed during a global period was unrelated to the original surgery?
- Modifier 78
- Modifier 79 (Correct answer)
- Modifier 58
- Modifier 24
Correct answer: Modifier 79
Modifier 79 indicates an unrelated procedure or service performed by the same physician during the postoperative period.
Question 7: A patient returns within the global period after a skin excision for a wound dehiscence repair. The repair is directly related to the original procedure. Which modifier applies?
- Modifier 79
- Modifier 24
- Modifier 78 (Correct answer)
- Modifier 58
Correct answer: Modifier 78
Modifier 78 is used for an unplanned return to the OR for a related procedure during the postoperative period.
CPCA Modifier Use in Dermatology 2
A dermatologist performs a shave removal of a benign lesion on the back and, during the same session, destroys a premalignant actinic keratosis on the forearm.
Which modifier is appended to the destruction code?