Count on Pathology Report for Correct Lesion Excision
Question: I’m coding a lesion removal. The provider submitted part of the lesion to pathology but doesn’t have the results back yet. Can I still submit a claim? Arkansas Subscriber Answer: You cannot report a malignant lesion removal without confirmation from pathology that the lesion is indeed malignant. If you cannot wait for the pathology report to submit the claim, you can code the procedure as benign lesion excision. Depending on the documentation, including the size of the excision, you have the following coding options. And remember: CPT® differentiates the excision of lesions from the shaving of lesions or removal by any means except excision, as well as the removal of skin tags and paring of calluses. For benign lesion excision, you’ll choose a code from the 11400 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less) through 11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm) code set. If the lesion is malignant, you’ll choose a code from 11600 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less) through 11646 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm). Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
