11402 re-excision

wezegon1

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Help with coding11402 re-excision

My question is: My doctor performed an excision 11402 ( Excision Benign lesion 2.0cm) on 10/26/16. Pathology came back: Elliptical excision -juntional melanocytic nevus with architecutural disorder mild and focal moderate atypia extending to perpheral margin: See Comment: The lesion extends to the peripheral margin. Should any lesion remain or should this lesin recur, conservative re-excision is suggested. Her dermatologist wanted it re-excised. Do we use the same cpt code 11402. If yes do we need a modifier? Can we code this second excision as: 12031 (Repair intermediate) an additional 2.0cm was removed at this session. DX: D48.5. I cannot find any guild-lines on this. Could someone help me?
 
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CatchTheWind

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The second procedure will be an excision, so it should be coded as such. You won't need a modifier unless you are within the 10-day global period. Where it gets tricky is billing for a lesion that is benign, but atypical. CP Assistant (August 2000, pages 5-6) addresses the issue as follows:

When the morphology of a lesion is ambiguous, choosing the correct CPT procedure code relates to the manner in which the lesion was approached rather than the final pathological diagnosis, since the CPT code should reflect the knowledge, skill, time, and effort that the physician invested in the excision of the lesion. Therefore, an ambiguous but low suspicion lesion might be excised with minimal surrounding grossly normal skin/soft tissue margins, as for a benign lesion (codes 11400-11446), whereas an ambiguous but moderate-to-high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion (codes 11600-11646).
 
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