Remember to Code These Lesion Treatments Separately
Question: Encounter notes indicate that the emergency department (ED) physician shaved a pair of epidermal lesions: one on the patient’s upper leg that was 0.5 cm in diameter; and one on the patient’s trunk that was 1.1 cm in diameter. Should I report separate codes for each lesion, or code based on the total lesion excision diameter? Tennessee Subscriber Answer: You should report the lesion shavings separately. On your claim, report 11302 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm) for the trunk lesion shaving, and 11300 (… lesion diameter 0.5 cm or less) for the upper leg lesion shaving. Since the codes both share the same root descriptor, you might be tempted to total the diameters and report a single shaving code. You should not pursue this course, however, as the descriptors indicate shaving of a “single lesion.” Modifier alert: Most payers want you to use modifier 59 (Distinct procedural service) or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) on 11300 to show that the shaving was distinct from the 11302 shaving. If you are unsure of whether to use a modifier, check with your payer as rules for epidermal shaving codes can vary. Also, be sure you know what anatomical area the ED physician shaves. The anatomy for 11300 through 11303 (… lesion diameter over 2.0 cm) is trunk, arms, or legs. The other epidermal lesion shaving codes concern themselves with other parts of the body. After 11300-11303, the Shaving of Epidermal or Dermal Lesions section of CPT® includes these codes: Chris Boucher, MS, CPC, Senior Development Editor, AAPC
