Yes, you can report both codes separately. While the excision of a skin lesion is included in an adjacent tissue transfer at the same anatomic site, the lesion excision is not included in a full thickness skin graft and conversely the full thickness skin graft is not included in a lesion excision. Here are a couple of guidelines you may be able to share with your physician that might help him feel more comfortable billing both codes:
From the CPT guidelines for excision of malignant skin lesions: F
or excision of malignant lesions requiring more than simple closure, ie, requiring intermediate or complex closure, report 11600-11646 in addition to appropriate intermediate (12031-12057) or complex closure (13100-13153) codes. For reconstructive closure, see 15002-15261, 15570-15770.
From the NCCI Policy Manual, Chapter 3, Section E:
Lesion removal may require closure (simple, intermediate, or complex), adjacent tissue transfer, or
grafts. If the lesion removal requires dressings, strip closure, or simple closure, these services are not separately reportable. Thus, CPT codes 12001-12021 (simple repairs) are integral to the lesion removal codes.
Intermediate or complex repairs....and grafts may be separately reportable if medically reasonable and necessary. However, excision of benign lesions with excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440) includes simple, intermediate, or complex repairs which shall not be reported separately. If more than one lesion is removed and one of those lesions is larger than 0.5 cm, an intermediate or complex repair may be reported, if performed, for a lesion larger than 0.5 cm. Removal of one lesion smaller than 0.5 cm does not preclude also reporting an intermediate or complex repair for a larger lesion.
I hope that helps - have a great night!
Kim
www.codingmastery.com