General Surgery Coding Alert

Define depth for shaving codes.

Maybe you can drill down to the correct procedure code for a skin case once you’re in the proper section, but how do you make sure you get to the right CPT^® code family in the first place?

Answer the following four questions, according to our experts, and you’ll get to best code for your skin case — every time:

• What is the surgeon’s purpose for the skin removal?
• How deep did the surgeon cut into the layers of skin?
• Where on the patient’s body did the surgeon perform the procedure?
• How big was the incision?

Zero in on Purpose

When a surgeon removes a skin section from a patient’s body, the reason for the procedure is typically to diagnose a problem, to relieve a condition or, in some cases, both.

If the surgeon is confronted with a skin lesion and needs to sample a small portion of tissue to submit to pathology to provide a diagnosis, you should turn to the biopsy codes, as follows:

• 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion)
• +11101 (...each separate/additional lesion (List separately in addition to code for primary procedure)).

Don’t use these biopsy codes if the surgeon removes an entire lesion for the purpose of treating a skin condition. In those cases, you should turn to excision codes for benign or malignant lesions, for hidradenitis, or shaving codes, as follows:

• Excision benign lesion (11400-11446, Excision, benign lesion including margins…)
• Excision hidradenitis (11450-11471, Excision of skin and subcutaneous tissue for hidradenitis …)
• Excision malignant lesion (11600-11646, Excision, malignant lesion including margins …)
• Shaving (11300-11313, Shaving of epidermal or dermal lesion, single lesion…).

Determine Depth for Accuracy

Now that you know the surgeon is treating a skin condition by removing the lesion, not just sampling it, you need to distinguish between CPT^® codes for lesion excision versus shaving.

Key: If you know the depth of the lesion removal, you can accurately choose between excision and shaving codes. For coding purposes, CPT^® narrowly defines excision as involving full thickness removal of the lesion through the dermis. Shaving, in contrast, involves sharp removal of some skin layers without a full-thickness dermal excision.

Terminology caution: Surgical reports can be confusing. For instance, if the surgeon uses the term “shave biopsy,” focusing on the word “shave” may lead coders to report a shave removal, when in fact, the key word may be “biopsy,” cautions Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. Look for mention of lesion removal depth to determine if the case really is a shave procedure.

Look for closure notes: Lesion excisions typically require closure, and the codes include simple closure, such as single-layer sutures, while shaving does not require sutures.

Opportunity: If the procedure is a benign or malignant lesion excision, you can separately report intermediate or complex closure using an appropriate code from the range 12031-12057 (Repair, intermediate …) or 13100-+13153 (Repair, complex …).

Check Location for these Procedures

To choose the correct code for a shaving or excision procedure, you must answer the question, where on the patient’s body the surgeon performed the procedure.

Here’s why: CPT^® groups both shaving and excision codes by body site, as you can see in the Table.

Watch biopsy site, too: Although CPT^® lists just two general codes for skin biopsy (11100-+11101), those are not always the best codes to describe the procedure your provider performs, warns Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. That’s because other site-specific biopsy codes may better describe a procedure, such as 40490 (Biopsy of lip).

Measuring Size Might Not be so Simple

CPT^® divides each of the skin shaving and excision code families by size, with dimensions built into the code descriptors for fast reference. For a shaving code, such as 11300 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less), the diameter refers only to the lesion itself.

Excision codes, however, are a little trickier. CPT^® guidelines indicate that for benign or malignant excision codes, you must calculate the diameter to include the margin measurement.

Example: If your surgeon excises a benign lesion with a diameter of 2 cm from a patient’s hand and reports leaving a 0.2 cm margin around the lesion, you would add 0.4 cm (0.2 cm x 2) to the lesion diameter for a total value of 2.4 cm. That means you would report the procedure as 11423 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm).

Caution: The procedure note may not document the size of the lesion and the area of the margins, according to Witt. In that case, you’ll need to consult the surgeon so that you can get the correct size for coding purposes. For code selection, always use the narrowest margin times 2, especially in the case of an elliptical incision where one of the margins is very long.