ED Coding and Reimbursement Alert

Don't count margins in 11300-11313. When applying codes 11300-11313 for shaving of epidermal or dermal lesions, you must follow a different set of rules than when you report more familiar lesion excision codes 11400-11646. More fundamentally, you may not always be clear on when you should select 11300-11313 rather than the excision codes or, for that matter, a biopsy code. Here are the facts you need to identify and report shaving procedures properly. Consider Depth to Distinguish Shaving To differentiate between shaving (11300-11313) and excision (11400-11646), you should first look at the removal's depth . Technically, anytime the ED 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, by comparison, involves "sharp removal ... without a full-thickness dermal excision." "Shaving implies a superficial removal," says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates. In some cases, the physician may remove the raised portion of a benign lesion and allow additional lesion tissue to persist in the dermis. The ED physician's method to remove a lesion better reveals the difference between shaving and excision. During shaving, the physician uses a "transverse incision or horizontal slicing," as CPT says, to remove the lesion. That is, the physician holds the blade horizontal to the skin and moves it across the lesion, literally shaving it off. Excision, in contrast, usually involves holding the blade perpendicular to (and thus cutting through) the skin to remove the lesion at a greater depth. In these cases, the physician always wishes to remove the entire lesion to the greatest necessary depth. "Read the documentation carefully," Bishop says. "Physicians may use terms like -shave biopsy- for a procedure CPT might describe as an excision." Bottom line: Pay more attention to the removal's depth than to the terminology your physician uses. A final clue that may help you differentiate between shaving and excision is whether the surgical wound requires repair, Bishop says. Although excision frequently requires suture or separate repair, shaving "does not require suture closure," CPT says. (For more information on coding lesion excision, see "Discover Pathology Before Choosing Excision Code" in ED Coding Alert, Vol. 11, No. 4 .) For Shaving, Rely on Lesion Size Only When reporting shaving procedures, you must not consider the size of any margin the ED 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. CPT groups shaving codes into three categories, as determined by the lesion's location: - 11300-11303 -- trunk, arms, or legs - [...]