Excision coding-Doctor excised

mitzfritz215

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Doctor excised skin/chest lesion for biopsy on 03/12. Sent to lab and came back basal cell carcinoma size 2.1 x 1.2 x 1.1 cm surface area of 0.5 in diameter and suggests further removal. Came back on 04/13 and excised 2.3 x 1.2 x 0.9 surface area 1.3 x 0.4 cm. Am I able to bill for the 1st and 2nd excision? In class we were told to calculate the largest size of the lesion plus the margin times 2. Is that correct? Do I only bill for the largest lesion or for both sizes since they were a month apart? Would I bill a 11603 for the 1st and 11606 for the 2nd? Would I also bill for simple repair for the 1st 12002 intermediate repair 12032 even though it reads a simple repair is included? Post operative period? 10 days? Do you also bill an E/M code?
Another patient - excision on skin/back lesion - sent to lab - came back as lipoma size 4.3 x 3.5 x 2.0 cm. E/M code plus 11606? Simple repair for something that big or intermediate?
Confused and need Help - thanks
 

mitchellde

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Ok 2 separate excisions can each be billed no problem. You use the largest diamenter from each individual excision for that code. If you do not know the margins of the excision then you will have go with the measurements from the path report so the first one will be based on the code for sise of 2.1 cm and if the repair was a simple repaire it cannot be coded. The second excision is out of the global so no modifier is needed and it will be based on the size of 2.3 cm and if the repair is documented as an intermediate then you may also code and bill it.
If the repair is not documented as a lyered repair then it cannot be billed, the repair of simple vs intermediate is not based on the size of the excision per se, rather the depth of the excision. If the provider just states the wound was closed then we must assume simple repair and it cannot be coded. We can never assume an intermediate just due to size. As far as can you code an E&M plus an excision, that depends on the documentation.
 

mitzfritz215

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When you are determining the size of the lesion 2.1 x 1.2 x 1.1 is it calculated :
2.1 + (1.1 x 2) = 2.1 + 2.2 = 4.3 ?
This is what they taught us in class on how to determine the diameter. Is it correct? I want to make sure that I don't bill the wrong code. Would I use 11606 for 4.3 cm or 11603 for 2.1 cm?
Thanks
 

mitchellde

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when the size is given as 2.1x1.2x1.1 the provider is giving length, width, and depth of the lesion or excision. If he does not state something like plus 2 cm margins, then you can only assume the size given includes the margins and you go with the largest diameter. If he tells you plus 1.1cm margin then you would add 1.1 x 2 for each side to the largest measurment of 2.1. From what you have stated it looks like you are being given the excised diameter so you would go with the largest of 2.1 for the code.
 
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