ED Coding and Reimbursement Alert

Question: Our ED physician removed a benign lesion and isn't sure how to calculate the excision size? Also, when should we measure the excision area - before or after the lesion goes to pathology?

Codify Subscriber

Answer: When calculating lesion excision size for coding purposes, the physician should measure the total excised diameter.

How?  First, find out the exact size of the lesion. Per CPT^®, code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision. In other words, excision diameter + the narrowest margins required = the excised diameter.

So let's say the ED physician treats a lesion on the patient's left leg. The operative report indicates that the lesion was benign; the lesion was 2.6 cm at its widest point, and the ED physician also had to remove a margin of 0.3 cm on either side of the lesion.

To come up with total excised diameter, add the lesion diameter (2.6) and the margin (0.3 + 0.3), and the diameter would be 3.2cm. On the claim, you would report 11404 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm) for this encounter.

Pre- or post-pathology? Lesions will shrink during the pathologist's analysis, so have the physician measure and document the excision area, then send the lesion to pathology.