Urology Coding Alert

Question: One of our patients had a recurrent penile lesion after having a radical circumcision for a suspicious squamous cell cancer. The urologist performed a radical excision of remaining redundant foreskin, and when I asked him if he had done enough for me to code a partial penectomy, he said no, but that he had done more than just a circumcision. Can you help me code this?

Ohio Subscriber Answer: From your description it sounds as though the urologist performed a circumcision during the first procedure and, during this follow-up procedure, he performed an excision of a local penile recurrent lesion, most likely malignant. If this is in fact the case, you should look at CPT codes 11620 to 11626 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia ...).

Choose correctly: Base your code choice on the size of the tissue removed, which means the lesion size plus the margins excised.

Example: If the urologist documented the lesion and the excised area as being 1.2 cm, you should report 11622 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm).

Tip: All excisions include simple closure. If the physician had to perform a more difficult (intermediate or complex) closure, you may report the closure separately. In this case, if the urologist performed more than a simple repair in addition to the excision, you may also bill 12041 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less) for an intermediate repair or 13131 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm) for a complex repair.