Otolaryngology Coding Alert

One of the biggest changes for CPT 2003, which will affect virtually all practices, is how physicians should measure lesions. Measure Excised Diameter, Not Lesion Diameter Lesion coding has been based on the lesion's size, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. CPT changes that method and bases the benign (11400-11446) and malignant (11600-11646) lesion size on the excised diameter, including the narrow margins, rather than the lesion diameter. The following Excision Benign Lesions introductory language from CPT 2003 establishes this alteration:

Excision (including simple closure) of benign lesions of skin (e.g., neoplasm, cicatricial, fibrous, inflammatory, congenital, cystic lesions) includes local anesthesia. See appropriate size and area below. For shave removal, see 11300 et seq., and for electrosurgical and other methods see 17000 et seq. Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed. Report separately each benign lesion excised. Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter). The margins refer to the most narrow margin required to adequately excise the lesion, based on the physician's judgment. The measurement of lesion plus margin is made prior to excision. The excised diameter is the same whether the surgical defect is repaired in a linear fashion or reconstructed (e.g., with a skin graft). To reflect the new mandate to measure the clinical diameter of the excision, plus the narrowest margins necessary for complete excision, the definitions for 11400-11446 now include the narrow margins:

11400-11426 Excision, benign lesion including margins
11440-11446 Excision, other benign lesion including margins. The lesion diameter now refers to the excised diameter:
e.g., 11440 Excision, other benign lesion including margins (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less. Otolaryngologists will have to forget lesion size in their operative reports and list, instead, the excision size, as well as the narrow margins, Cobuzzi says. This is a huge shift from the way coders have instructed doctors to measure lesions, she points out. "Physicians and coders will require a major re-education."

The new wording reinforces how important it is for the physician to document the size before lesion removal, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. "The doctor must now note that information and participate in determining the size by documenting the expected margin as well," she explains. "With the old method of coding, a nurse could document the [...]