Combining sizes for lesions?


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Hi All!

I'm a Urology coder, but I think I need a little Derm expertise to make sure I'm correct in my thinking. One of my docs removed approximately 20 scrotal skin lesions - he called them Calcinosis - from one patient. He said the average size was about 1cm each. I know with some lesions you can combine the size for one code, but I also know that there's very few codes that go over 4cm. So here's my question - do I go 11424, mod 22 or 11424, 11424-76, 11424-76, 11424-76 or FB removal from scrotum? Or is there another way to do this that I'm not thinking of? He's got BCBS Pathways HMO if that matters.

Edited to add: Each site was incised with 15-blade scalpel and the calcium deposit under the skin was removed with blunt and sharp dissection.

Thanks in advance!
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True Blue
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No, you don't combine sizes for the excision codes, only for the closure - per CPT instructions, each lesion excision has to be reported separately. You would need the size of each individual lesion to be able to correctly code this - you can't really code excisions just using the 'average size' of all lesions excised at the encounter.

I'm also not sure if what you have here really supports and an excision code at all - again per CPT, excisions are "defined as full-thickness (through the dermis) removal of a lesion" and that is not what you've described here. You may want to query the provider for clarification of his technique, but in the absence of additional documentation, I am inclined to think that 17111 would be a more appropriate code for this.