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?