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Question: I have an operative note that states the surgeon “removed” a 1.6 cm basal cell carcinoma (BCC) that was diagnosed by a prior biopsy. I’m unsure if the surgeon performed a destruction or an excision to remove the BCC. How should I report this procedure?

Alabama Subscriber

Answer: Excision and destruction are two methods of treating BCC, but excision is the more common procedure. Excision occurs when the surgeon removes tissue to eliminate the cancer and submits the tissue for pathologic diagnosis. Destruction is when the physician doesn’t remove the tissue for analysis and eradicates the cancer cells. While the two methods both remove the cancer from the patient, you need to take special care to select excision or destruction codes correctly.

Look for measurements: The surgeon performs an excision when they remove lesion of a specific size. In your case, you’ll select a code such as 11602 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm) to report the BCC excision. The CPT^® code set features 18 codes in the 11600-11646 (Excision, malignant lesion including margins …) code range to choose from, based on the malignant (cancerous) lesion’s anatomical site and the size of the excision in diameter. However, you do not want to use a code from the 11400-11446 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere) …) code range because these codes are designated for benign (noncancerous) lesion excisions.

Check for equipment: If the op note includes wording about a specific method, such as laser ablation, to obliterate the cancer cells, you’ll opt for a destruction code. For BCC destruction, look to the 17260-17286 (Destruction, malignant lesion …) code range. Simultaneously, you’ll want to avoid the 17000-17004 (Destruction … premalignant lesions …) code range since these destruction codes are reserved for premalignancies.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC