Curretage with Excision

jmessick

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When billing for an excision it should be clearly documented the lesion size plus the margins. I have doc that is curreting a malignant lesion and then placing margins for an excision. Would you take the lesion size before or after curreted. Thanks
 
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Lesion size measured BEFORE excision

Lesion size should always be measured / recorded BEFORE excision, biopsy, etc

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

DeeCPC

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Did the doctor do an ED&C-Electrodesiccation and curettage?

With an ED&C the provider may measure then after treatment have to go beyond that original measurement. This is because the cancer below the skin is wider than visibly seen above the skin. I have asked my doctors to do a before and after measurement.

Dee
CPC, CPMA, CPCD
 

jmessick

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Still a little confused. On the same site/ the doctor indicates the lesion size and the lesion size after ED&C. Then he excises the same lesion. From which size would you add the margins to get the diameter?
 

DeeCPC

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That is odd. I have never seen the same lesion excised after an ED&C. Anyway we could see the note? Is there an explanation of why he/she didn't start with the excision?

Same lesion then only one code can be billed.

You stated, 'which size would you add the margins to get the diameter?' I think a review of the note would be the only way to give good advice.

Dee
CPC, CPMA, CPCD
 

mitchellde

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Still a little confused. On the same site/ the doctor indicates the lesion size and the lesion size after ED&C. Then he excises the same lesion. From which size would you add the margins to get the diameter?
If he did the ED&C to "get a better look" at the lesion below the surface, and if the lesion is bigger now because he can see it better the use the largest measurement after the ED&C if is is smaller then use the largest measurement prior to. The end result is take the largest measurement.
 

DeeCPC

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As with many posts here, the note is required to make sure the question matches the documentation. I field many questions every day at work and only a few match the note once I read it.

My concern is the statement, 'From which size would you add the margins to get the diameter?" You cannot add margins to the post ED&C site if the provider is not saying the size of that defect plus 'xxmm margins' was excised. If they do not tell you the margins you can't assume anything.

Excisions are often larger than the lesion plus margins for closure issues and that is why you have to use the lesion plus margins and not the final defect size or other poorly worded documentation.

Dee
CPC, CPMA, CPCD
 

mitchellde

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Dee is correct regarding the margins, I was referring strictly to the lesion size, the margins would need to be specifically stated as to the size outside the excision. and it can not be stated enough that the margin size cannot be assumed. Many times I only get the excised diameter documented and that is what I have to go by, even though other coders have state to always assume a margin of "x" size. A procedure note would help us to better address your question.
 

jmessick

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There is a 1.0 x 1.1 cm biopsy site (this was also the original size on previos note when biopsy was performed). A 1.5 x 1.0 cm area was curretted prior to excsion with 4mm margins into the SQ layers and the area was excised with scalpel blade. Final excised defect was 2.3 x 1.8 cm. Extensive undermining was performed and standing cone repair was required for a flat functional repair Complex closure. Final size 5.3 cm.


thanks
 
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