AAPC Medical Coding & Billing Forums Claculation of the diameter of skin excision.
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#1
11-12-2009, 08:25 AM
 Mohana Prasad Networker Join Date: Apr 2007 Posts: 27
Claculation of the diameter of skin excision.

Hi:

Can any one help me to find out the diameter of the excised skin. The doctor has documented that he has excised a bening lesion 2.0 x 1.1 x 0.8 cm.

Also kindly tell me if there is any formula to find out the diamenter for the lesions docmented in the above mentioned dimension format.

Thanks,
#2
11-12-2009, 08:35 AM
 wwsteves Contributor Join Date: Apr 2007 Posts: 16

You use the greatest measurement of the diameter (distance across the lesion) and you add to that the margin required for complete excision (determined by the physician). If the physician does not document a margin, simply use the greatest measurement given. In this case, you would use a diameter of 2.0 cm.
#3
11-12-2009, 11:02 AM
 Mohana Prasad Networker Join Date: Apr 2007 Posts: 27
Calculation of the diameter of skin excision.

Hi:

Thank you Steve & Jackie for you guidance.

Kinldy explain the dimension 2.0 x 1.1 x 0.8 cm. Is 2.0 is the real diameter of the lesion alone nad 1.1 & 0.8 is the length of the margins.

Also if the patient had muliple lesions on the same anatomical area (Eg:Trunk) and all the lesions were excised. Can we sum up all the diameter and code or should we code each lesion seperately with modifier 59.

Thanks & Regards,
#4
11-12-2009, 06:02 PM
 mitchellde True Blue Join Date: Apr 2007 Location: Columbia, MO Posts: 7,811

Quote:
 Originally Posted by jgf-CPC I have this table to use: To calculate the excised diameter, you should begin with the size of the lesion (2 cm) and add the width of the narrowest margin multiplied by 2 (1.5 x 2, or 3 cm total) for a total of 5 cm (2 + 3 = 5). Possible problem: When calculating excision diameter, be careful not to confuse the length of the incision with the size of the excision Hope that is not confusing to you! It helped us lots.
I really need to ask where this information came from, because in no way can you code this lesion as a 5cm excision. You do as already posted, that is use the largest diameter. It goes by EXCISED diameter, if the physician states he excised this lesion and gives this dimension then we take that at face value that that is the excised diameter. Or if her gives the lesion size and then states he excised with 2cm margins, you take the largest diameter, in this case 2cm, and then add the margin on each side so it comes to 2+2+2. But in the example posted you only have the excision statement to go with so it will be coded as a 2 cm excision. As a coder we can make absolutely no asumptions about the size of the excision other that what is stated.
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Debra A. Mitchell, MSPH, CPC-H
#5
11-13-2009, 07:15 AM
 jgf-CPC True Blue Join Date: Apr 2007 Location: Columbus GA Posts: 570

It took a lot of searching to find where the notes came from but is was from Medical Newswire issue 11/7/05...sorry it took me so long....J.
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Jackie, CPC

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#6
11-13-2009, 02:39 PM
 FTessaBartels True Blue Join Date: Apr 2007 Location: Milwaukee WI Posts: 4,417
Agree with Debra

I agree with Debra on this one. The guideline for measuring the size of lesion is spelled out in CPT (2009 professional edition, page 54 bottom of 1st column): "lesion diameter plus the most narrow margins required equals the excised diameter." (emphasis added by FTB)

Unless the physician specifies the margin I cannot assume what is the most narrow margin required. And furthermore, the size of the excisional wound may be quite a bit larger than this "excised diameter" to allow for appropriate closure. Look at the diagram in CPT 2009 professional edition on page 54, top of left-hand column. The lesion itself is 2.0 cm. The margin is 0.2 cm. But the length of excision (the long oval dotted line), is easily twice the length of the lesion itself.

You cannot assume, you cannot use a standard formula. The physician must specify. The appropriate margin will be different for a benign lesion vs a malignant lesion. And the location of the lesion, and type of closure required will further complicate this.

I educate my physician's to state "lesion measuring LxWxD; excised diameter with margins x cm; resulting in excisional wound of Y length" (That's how I educate them; they don't always comply.)

Hope that helps.

F Tesssa Bartels, CPC, CEMC

Last edited by FTessaBartels; 11-15-2009 at 06:48 AM.
#7
11-13-2009, 07:58 PM
 Susan Expert Join Date: Apr 2007 Location: Glendale Posts: 388

Quote:
 Originally Posted by Mohana Prasad Hi: Thank you Steve & Jackie for you guidance. Kinldy explain the dimension 2.0 x 1.1 x 0.8 cm. Is 2.0 is the real diameter of the lesion alone nad 1.1 & 0.8 is the length of the margins. Also if the patient had muliple lesions on the same anatomical area (Eg:Trunk) and all the lesions were excised. Can we sum up all the diameter and code or should we code each lesion seperately with modifier 59. Thanks & Regards, N. Mohana Prasad.
I also agree with Debra on this, but to answer your second question in regards to multiple lesions removed, you would not need to use modifier 59 in this case as they are not "bundled". Check with your carrier, but my physician often will remove more than one lesion in the same body area and we do NOT code with modifer 59. I always check the NCCI edits first and then check my carrier guidelines prior to submitting the codes. Hope that helps.
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Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC
AAPCCA Board of Directors
Region 8 - West
AAPC Expert ICD-10 Trainer

susan.ward@aapcca.org

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