Wiki Excision Coding

[honey1315@hotmail.com]

I am new to dermatology and still trying to get the hang of measuring and coding excisions. My provider always does great notes, but I find myself getting stuck when she does excisions of a lesion after there has already been a biopsy and pathology report done. So, for example, pathology confirmed Granuloma/epidermal inclusion cyst and excision was performed on Rt anterior shoulder. She gave the specimen size 1.5cmx 7mm and then the final length of incision as 2cm. There is no mention of margins. Or she will do a punch excision after pathology report has come back and give the measurements as say 6mm x 6mm and then the final incision size as say 2.3. Can I determine the proper size to code from this? Or do I need more information to determine the appropriate size and code?

 

[nickelclaw]

Hello,
for the specimen size add 1.5+.07 (7mm=.07cm)=2.2cm excision with repair being 2cm if intermediate or complex repair.
query or ask if the specimen size that is given already includes the margins (7mm) if so then add if not then code the 1.5cm as size.

from CPT assistant Aug 2021:
Coding Tip
Selection of the appropriate excision code is determined by three parameters: location, maximum excised diameter (which includes the margin), and lesion type (ie, benign or malignant). When the lesion is clearly benign (eg, cyst, lipoma, prior biopsy of benign neoplasm), the excision can be coded as benign at the time of surgery (11400-11471). When there is a prior biopsy showing malignancy, the excision can be coded as malignant at the time of surgery (11600-11646). In addition, if the lesion is not clearly benign or malignant, coding and billing should be delayed until the pathology has been confirmed.

 

[thomas7331]

Hello,
for the specimen size add 1.5+.07 (7mm=.07cm)=2.2cm excision with repair being 2cm if intermediate or complex repair.
query or ask if the specimen size that is given already includes the margins (7mm) if so then add if not then code the 1.5cm as size.

This isn't correct - you would select the largest of the measurements (maximum excised diameter), not add the measurements together. If the provider is giving two measurements like this, it's an oblong lesion or specimen, so you'd just take the largest measurement and use that for you excision size. Adding the two together may result in an incorrect code.

For a benign lesion, you won't usually see margins, so I wouldn't query in this case. If you see malignant or suspicious lesions being excised without mention of margins, then I would speak to the provider to make sure they are including margins in their measurements.

I'd also recommend having the provider document the length of the repair rather than the length of the incision. While these are likely the same in most cases, it is the length of the final repair that is done which will determine what repair code is reported.