Lesion Excision Coding Challenge: 2 Lesions, 1 Cut

Posted on 31. Jul, 2009 by .

Question: Our nonphysician practitioner (NPP) discovers a pair of benign lesions on a patient’s right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with a single excision. Should I report one or two excision codes?

Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Add the lengths of the two excisions to the margin between the lesions, and choose a code based on that length. (In your scenario, 0.5 + 0.3 + 1.0 = 1.8 cm.). On the claim, report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm) for the excision.

AUDIO: Lesion Excision Coding Made Easy, with Betty Johnson.

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Shave or Excision?

Posted on 03. Feb, 2009 by .

Sharpen your lesion coding prowess with this tip from John Bishop: Read the documentation carefully, and pay more attention to the removal’s depth than to the terminology your physician uses.

Technically, any time physician removes skin tissue, he’s performing an “excision.” For coding purposes, however, CPT narrowly defines an excision as involving “full-thickness (through the dermis) removal of a lesion.”

Shaving, in contrast, involves “sharp removal … without a full-thickness dermal excision.” When reporting shaving procedures, you must not consider the size of any margin the physician removes with the lesion. In fact, the physician may not document, or even take, a margin of tissue during a shave. This is a crucial difference from coding for excisions.

Support medical necessity on your lesion removal claims with these tips from Joanne Schade-Boyce.

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