How To Code Cpt For Size Of Repair Of Skin Lesion

Skin Lesion Excision: Answer 3 Questions to Code Correctly

To accurately code for pare lesion excision, you need to extract from the documentation the answers to three very of import questions:

Was the lesion benign or cancerous?
Where was the lesion located (anatomic site)?
What was the excised diameter of the lesion?

Let'south examine how these parameters are determined, and how they bear on your lawmaking selection.
Determine Classification
Peel lesion excision codes fall into two main classifications: Those describing benign (not-cancerous) lesions and those describing cancerous (cancerous) lesions. You must determine from the pathology report whether the neoplasm is benign, in-situ, malignant, or of uncertain histologic behavior.
If the pathology report describes a benign lesion, or one of uncertain beliefs (due east.one thousand., indications of atypia or dysplasia), you must utilise a benign lesion CPT® code (11400-11446).
To assign a malignant lesion CPT® code (11600-11646), the pathology written report must confirm a malignancy, which may be principal (malignancy at the site where a cancer begins to grow), secondary (malignancy has spread from the primary site to other parts of the torso), or in-situ (an early-stage tumor that may evolve into an invasive malignancy).
Be certain that your code selection is backed upward by the pathology study, even if that means holding the claim for a few days. If you don't have a pathology report to confirm the diagnosis, you lot must assign an unspecified diagnosis and a benign lesion excision CPT® lawmaking (11400-11471). The only legitimate exception to this rule is if the provider performs a re-excision to obtain clear margins at a later operative session. In such a case, study the aforementioned diagnosis as that used for the initial process.
Determine Location
Study each skin lesion excision independently, using the following site-specific classifications:
Benign lesion

Trunk, arms, legs – 11400-11406
Scalp, neck, hands anxiety, genitalia – 11420-11426
Face up, ears, eyelids, nose, lips, mucous membrane – 11440-11446

Cancerous lesion

Trunk, arms, legs – 11600-11606
Scalp, neck, hands, feet, genitalia – 11620-11626
Face, ears, eyelids (pare only), nose, lips – 11640-11646

Determine Size
Size is of primary importance when reporting skin lesion excision. Per CPT®, "Code selection is adamant past measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision." The margin is further defined equally "the nigh narrow margin required to adequately excise the lesion …."
In plain language, the excised diameter equals the length of the lesion at its longest point, plus two times the narrowest margin. For instance, if the lesion measures 1 cm at its greatest, and the surgeon removes a margin of 0.5 cm on all sides, the total excised diameter is two.0 cm (1.0 cm + [ii x 0.five cm]).
Your physician should measure the lesion plus margin before the excision. Do not select codes based on the size of the incision and/or the resulting surgical wound.
Put It All Together and Lawmaking It
When you accept the facts—classification, location, and size—yous are ready to code the service. Here are a few examples of how you might use the information to determine proper coding.
Example 1: A surgeon excises a cancerous lesion from a patient's right shoulder. Prior to excision, the lesion measures one.0 cm at its widest. To ensure removal of all malignancy, the surgeon allows a margin of at least 1.0 cm on all sides, for a total excised diameter of 3.0 cm (1.0 cm + [2 10 ane.0 cm]).
The correct code is 11603 Excision, malignant lesion including margins, body, artillery, or legs; excised diameter 2.1 to iii.0 cm.
Case 2: The surgeon removes a single lesion from the left cheek. The lesion measures i.5 cm at its widest, around which the surgeon removes a margin of 0.v cm. The pathology written report reveals a neoplasm of uncertain behavior.
"Uncertain behavior" requires yous to report benign lesion excision (11400-11446). The location is the cheek, which narrows your pick to codes 11440-11446. The full excised diameter is 1.five cm (the lesion itself) plus twice the margin (2 x 0.5 cm = 1.0 cm), or ii.5 cm.
The correct code is 11443 Excision, other beneficial lesion including margins, except pare tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm.
Multiple Excisions Crave a Modifier
Care for each lesion excision as an individual and separate procedure, and link a verifiable diagnosis to each individual CPT® code for multiple excisions. Append modifier 59 Distinct procedural service to the second and subsequent codes describing excisions at the aforementioned location to avert duplication denials.
Example iii: The surgeon removes three lesions from the left arm, with total excised diameters of 0.v cm (beneficial), 1.v cm (benign), and two.0 cm (malignant). Proper process and diagnosis coding is:

11602 Excision, cancerous lesion including margins, trunk, arms or legs; excised diameter 1.1 to 2.0 cm with 173.6 Other malignant neoplasm of skin, skin of upper limb, including shoulder
11402-59 Excision, beneficial lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.i to 2.0 cm with 216.6 Benign neoplasm of skin; skin of upper limb, including shoulder
11400-59 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised bore 0.5 cm or less with 216.6.

"Re-excision" Calls for Special Consideration
The doc may revisit a previous excision to remove boosted material if pathology continues to show malignancy in the margins. How you report this depends on the timing of the follow-upward excision.
If the re-excision occurs during the same session as the initial excision, report a single code to describe the greatest area removed. For example, if the commencement excision measures 3.0 cm with margins, and the 2nd excision increases the margins by 1.0 cm on all sides, code for a 5.0 cm excision. Do not separately report a 3.0 cm excision and a 5.0 cm excision.
If the re-excision occurs during a subsequent session, nevertheless, base your code option on the bore of the new excision. For example, you lot written report 11603 Excision, cancerous lesion including margins, body, arms or legs; excised diameter 2.ane to 3.0 cm for the initial excision on Tuesday. Pathology indicates inadequate margins to remove all malignancy. The physician returns the patient to the procedure room three days later (Friday) and increases the margin by 1 cm on all sides. Report Friday's session using 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm, with modifier 58 Staged or related process or service by the same doctor during the postoperative menstruation appended because the re-excision occurred during the global period of the initial excision.

Excision Differs From Shaving, Destruction
In improver to the peel lesion excision codes (11400-11646), CPT® also includes codes to describe lesion removal past shaving (11300-11313), destruction (17000-17004), and dent or cutting (11055-11057). A few uncomplicated definitions distinguish between these diverse procedures.
CPT® defines excision equally "full-thickness (through the dermis) removal of a lesion including margins …" A pare lesion excision is performed with a scalpel held perpendicular to the skin, and involves cutting into the subcutaneous tissue to remove the entire lesion.
Past contrast, CPT® defines shaving equally "The precipitous removal past transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full thickness dermal excision." In other words, the physician uses a scalpel, placed horizontally to the patient's peel, to slice off a piece of the lesion.
Paring or cutting describes the removal of superficial tissue using a spoon-shaped surgical instrument called a curette (credit armondo). This procedure is also called curettement.
Lesion destruction occurs via laser surgery, electrosurgery, or other methods (but not a scalpel). Always expect a diagnosis of 702.0 Actinic keratosis with the premalignant lesion destruction codes (17000-17004).
Lesion Excision Bundling Concerns
When reporting skin lesion excision (11400-11646), in addition to other procedures at the same anatomic location during the same session, be on the spotter for the following bundling bug.
Do not report in add-on to lesion excision:

Local anesthesia
Elementary closures (12001-12018)

Report in addition to lesion excision:

Intermediate (12031-12057) and circuitous (13100-13153) repairs
Reconstructive closure (15002-15261, 15570-15770)

Practice not written report lesion excision in add-on to:

Next tissue transfer (14000-14350)

Author
Recent Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.