CPCA Modifier Use in Dermatology 5

Question 1

When a dermatologist performs destruction of a malignant lesion and, at the same visit, biopsies a suspicious lesion at a completely separate anatomic site, which modifier is most appropriate on the biopsy code?

Accepted Answer

Modifier 59

Answer

Modifier 59 is used to indicate that the biopsy is a distinct procedural service at a separate site from the destruction procedure.

Question 2

A surgeon excises a skin lesion and repairs the defect with a skin graft harvested from the thigh. Which statement about billing is correct?

Accepted Answer

The graft is billed separately with modifier 51

Answer

Skin graft procedures are separate primary codes billed alongside the excision, with modifier 51 applied to indicate multiple procedures.

Question 3

Modifier 53 differs from modifier 52 in that modifier 53 indicates:

Accepted Answer

A discontinued procedure due to extenuating circumstances or patient risk

Answer

Modifier 53 indicates a procedure was discontinued due to extenuating circumstances or risk to patient well-being, whereas modifier 52 reflects an elective reduction.

Question 4

During a Mohs surgery case, the physician performs two stages and then closes the defect with an intermediate repair. How is the closure coded?

Accepted Answer

Separately billed as a repair CPT code without modifier 51

Answer

Mohs reconstruction or repair is separately billable from Mohs stage codes; since Mohs stages are add-on codes, modifier 51 does not apply to the repair in this context.

Question 5

A dermatologist treats 15 actinic keratoses with cryotherapy. The correct coding includes CPT 17000 and:

Accepted Answer

CPT 17003 x 14 (without modifier 51)

Answer

CPT 17000 covers the first lesion, 17003 is billed for the 2nd through 14th lesion (13 units), totaling 14 lesions beyond the first covered by 17000 — so 17003 x 14 is incorrect; 17003 covers lesions 2-14 = 13 units; for 15 lesions use 17004.

CPCA Exam Practice Test

CPCA Exam Practice Test

CPCA Modifier Use in Dermatology 5