Need help with lesions excision guidelinse

[second to none]

In the guidelines for lesion excision defined that report separatelyy each benign or malignant lesion. Now how will you code the following questions?.


Q1 Excision with simple closure of 2.0cm diameter lesion, upper back, and 2.0 diameter lesion, left thigh. Pathology report reveals both were cystic lesions.
Answers: A11402 B11402, 11402 C11404
My teacher said, that the correct answer for question 1 is C. Can somebody explain it that which answer is correct and why?.
Q2 A patient has a benign lesions on the back and thigh. The physician excises the lesion on the back making a 2CM incision and makes a 1.5CM incision to remove .8cm lesion on the thigh. Answers: A11402 B11402,11402-59 C11401,11402

[mitchellde]

excisions must be code separately for each excision not added together, so if you have 2 excisions with the same code you will list it twice with a 59 modifier on the second so
Q1 would be 11402, 11402-59 the simple clousure is included
Q2 is 11402, 11402-59

[rthames052006]

Debra-

You are my favorite resource for lesion questions! I always look at the derm forum for that reason! I deal with Primary Care offices who do alot of in office skin procedures and you my friend are my 1st choice when it comes to derm.

Just wanted to say "thank you" for always sharing your knowledge with us! It's greatly appreciated !

[mitchellde]

Thank You Roxanne!

[second to none]

Hello Debra!

First of all thank you so much for explaining the questions. You make it clear that if two lesions are excised from same anatomic site, they should not be code it together. Every excised lesion must be code it separately. For example, if two lesions are excised from Neck, each of them are 0.5CM. We have to code 11420 twice with modifier 59 not 11421 for 0.6 to 1.0CM. Also if two lesions are take it out from same excision, we have to code it once not twice. Because only one excision is made not two.

[mitchellde]

You are correct!

[beckipoff]

Hi,
I'm hoping someone can provide me with some hard proof as to how a situation should be coded. I've seen some differing back and forth between the AMA CPT Assistants (May, 1996 and August, 2000) and the AAPC community.

I'm reviewing some of my Physycian's Pathology Reports and they come back with things like "excision of previously diagnosed Dysplastic Nevus, excision complete" OR "Junctional Melanocytic Nevus (Dysplastic/Clark's Type) with moderate atypia".
*Some resources state that Dysplastic Nevus are NOT malignant and should not be coded as such. They may have the potential to one day become malignant, but in the state in which they are removed, they are still considered benign.

*Other resources state that the Physician's time, skill, knowledge is what dictates the appropriate the CPT range.

My question really is this. Is a Dysplastic Nevi/Nevus a "neoplasm of unspecified nature"? Or is it benign? Which range of code of CPT codes are most appropriate and why? (114XX or 116XX)

Thanks so much in advance for anything you all could provide that would shed some light on this topic.

[mitchellde]

if you look it up, "atypia" is another way of stating uncertain behavior (238.xx).
An old CPT assistant from many years back instructed that if the path indicated uncertain then you code the following:
If the excision was narrow (small margins) then code as a benign excision CPT with the 238.x dx code
If the excision was wide (lg margins or "wide local excision") then code as malignant excision CPT with 238.x dx code

[beckipoff]

Hi Debra,
Thanks for the quick response! So you'd consider a Path report that states "dysplastic nevus" as acceptable for my Dr. to bill the malignant range?
Thanks so much!!

[DeeCPC]

Originally Posted by mitchellde

if you look it up, "atypia" is another way of stating uncertain behavior (238.xx).
An old CPT assistant from many years back instructed that if the path indicated uncertain then you code the following:
If the excision was narrow (small margins) then code as a benign excision CPT with the 238.x dx code
If the excision was wide (lg margins or "wide local excision") then code as malignant excision CPT with 238.x dx code

Anyway this CPT assistant could be provided? This contradicts what I have read about coding this scenario.

Please note this article by Dr. Janevicius an ASPS representative to the AMA CPT Advisory Committee. This is his comment under the header 'Coding excisions of neoplasms':

Many of these lesions are excised with margins. Report the excisions of neoplasms of uncertain behavior with the benign lesion excision codes, 114XX

http://www.psnextra.org/Columns/CPT-...June-2011.html

The lesion is not malignant and I would not code it as such.