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Primary Care Coding Alert

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Does a Single Cut Lead to Excision Exception?

Published on Sat Jun 06, 2009

Question: An FP performs a level-two E/M on a new patient, during which she discovers a pair of lesions on the patients right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with one excision. Should I report one or two excision codes for this procedure? Indiana Subscriber Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Because the provider excised multiple lesions with the same excision, you should add the lengths of the two excisions to the margin between the lesions, and choose a code based on that length. (In your scenario, 0.5 + 0.3 + 1.0 = 1.8 cm.) On the claim, report the following: " 11422 (Excision, benign lesion including margins, except skin tag [...]
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