Destructions of Malignant Lesions

Wendy Miller

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Many of the integumentary excision/removal codes require a calculation that includes the excised diameter of the lesion + factoring in the margins to arrive at the correct cm to bill. Now my issue, for the destruction of malignant lesions (codes 17260-17286), I see no guidance regarding how to determine the correct cm's to bill. I have found a few articles that kind of imply that you do factor in margins, "Destruction coded to: dimensions of each lesion plus margin" another article specific to cryo removal indicates "malignant lesions require margins of 5mm of clinical normal skin to ensure adequate removal". CPT seems to be silent on the issue. Part of me seems to think that you would go beyond the margins since you are dealing with a known malignancy. Does anyone know what the “coding rule “ is on this topic, code only the lesion size or do you factor in the margins?
That's an excellent question Wendy. I don't know of any coding rule, but my interpretation is that the measurement would be the lesion only, since the margins have already be excised. Anyone else have thoughts or know of a rule/guideline?
samples of lesion removal benign and malignant are on page 54-55 of the CPT 2008 Professional Edition coding book.
the upper picture is for benign, lower picture is for malignant -
other instructions clarified more under each heading.
Thanks for responding. My concern/confusion is that the examples on page 54 specifies "excision" not "destruction".
oh, I see...destruction is different excision - (misread your question) - I've never heard of a rule regarding margins when it comes to destruction of malignant or benign lesions.
Could you post the link to the articles you've found?
VERY interesting topic! :)
I would be happy to but it will have to be at a later date, I don't have the articles in my possession right now, they will be returned to me sometime next week.
Excision vs Destruction

My interpretation is based directly on CPT language ...

CPT descriptions for excision codes 11400-11646 all read "excised diameter ...' This means the diameter of the lesion, plus margin.

CPT descriptions for destruction codes 17620-17286 specify "lesion diameter..." This means the diameter of the lesion itself without margin.

GREAT question!

F Tessa Bartels, CPC, CPC-E/M
coding destruction of malignant lesion

How to code destruction of mutiple malignant lesion
Do I need to add the size of the lesion or code separate each lesion destruction?
( destruction code for malignant lesion dont have notes in it on how to code it)


You never add the lesions together for separate removals. If each lesion has a separate excision in the notes then they are coded separate. If the repairs are more than simple and in the same area then you add the lengths of the repairs together.
Hi Wendy...

Both the AAD and Inga Ellzey have great articles on the subject of malignant destructions. This exerpt is from Inga Ellzey:

Size After Curettage, but Before Electrodesiccation.

Destruction of malignant lesions (CPT codes 17260 to 17286) is selected based on the lesion size after curettage, but before electrodesiccation.

For example, a superficial basal cell carcinoma looks to be 1.2 cm/d clinically. The physician curettes the lesion, enabling him/her to visualize the extent of the lesion more accurately. After curettage, the lesion measures 1.5 cm/d. To assure complete removal, electrodesiccation is performed using 2-mm margins around the entire periphery of the curetted area, resulting in a final defect of 1.9 cm/d. The destruction code is selected based on a 1.5 cm/d measurement.

Hopefully this answers your question. Have a great day!