Primary Care Coding Alert

The New Year brings new and revised codes that will significantly affect family practices. Follow our guide to CPT changes and make 2003 a year of dollars instead of denials. 1. Lesion Excision Codes: One of the most significant changes concerns coding of benign and malignant skin-lesion excisions. CPT revised 11400-11446 (benign-lesion excisions) and 11600-11646 (malignant-lesion excisions) to include the measurement of margins in the determination of the correct code. In 2002, you chose the code depending on the location and size of the lesion only; now, code based on location and size of lesion and the skin margin, i.e., the "excised diameter."

For example, says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan., previously if the FP excised a 1.0-cm benign skin lesion from the patient's back with a margin of 0.2 cm on both sides, you would have reported 11401 (... lesion diameter 0.6 to 1.0 cm [2002 descriptor]). Now, you will use 11402 (... excised diameter 1.1 to 2.0 cm [2003 descriptor]) because the l.0-cm lesion size and 0.4-cm margin size (0.2 + 0.2) must be added together.

The measurements in the descriptors have not been changed, but the phrase "excised diameter" replaces "lesion diameter" to account for the margin measurement. Also, the words "including margins" were added to the root codes introducing each body location and to the preceding guidelines. As always, FPs should record the lesion size as the greatest clinical diameter. So, for example, if the lesion measures 2.0 cm x 1.0 cm, it is considered a lesion of 2.0 cm. The same new rules apply to the excision of malignant lesions. CPT also added new language for reporting additional excisions performed as a result of inadequate margin excision. Sometimes, FPs do not excise the whole lesion, a problem revealed only after frozen pathology. In such a case, the physician performs an additional excision to extract the remainder of the lesion. Coders in 2002 may have reported two codes, but CPT 2003 directs you to bill for one procedure by adding the entire margin together.

So, for example, says Daniel Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City, the FP performs an elliptical incision around a black mole of 0.2 cm with a margin of 0.3 cm on each side. Frozen pathology reveals that he didn't get the whole tumor, so he makes another incision with a 0.1-cm margin on each side and excises the remainder of the lesion, which is an additional 0.2 cm. Add together the 0.6 (0.3 + 0.3) and 0.2 (0.1 + 0.1) [...]