lesion excision

bwerner

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Can someone please help us code this. We keep reading the guidelines and trying to figure it out and got ourselves confused.

Lesion size 2.2cm x 1.5cm
Excision size 3.4c. x 2cm

Thanks!
Becky
 

cwpierce

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Code for the Excision size of 3.4cm and by the site of the lesion. Pay attention as to mailgnant or benign.

For a brief explaination: The lesion size is as listed above. Now when adding the narrowest excised margins to the lesion size you get an Excision size as listed above.

Lesion size: 2.2cm x 1.5cm
Margin size: 1.2cm x 0.5cm

Excision size: 3.4cm x 2.0 cm

Hope that helped.
 

BEARDOG

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Keep in mind the approach that was used for the excision:

From CPT-Assistant August 2000 pages 5-6



"When an excised lesion is a neoplasm of uncertain morphology (eg, melanoma vs. dysplastic nevi), choosing the correct CPT code relates to the manner in which the lesion is excised, rather than the final pathologic diagnosis, since the CPT code should reflect the knowledge, skill, time, and effort that the physician invests in the excision of the lesion.Example: An ambiguous, but low-suspicion lesion might be excised with minimal surrounding, grossly normal skin/soft tissue margins, as for a benign lesion. This would be most appropriately reported using the excision of benign lesion codes 11400-11446. An ambiguous, but moderate-to-high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion. This type of excision would be most appropriately reported using the excision of malignant lesion codes 11600-11646."

Your provider must be specific in the documentation there is moderate to high suspicion
that the lesion may be malignant to justify using the 11600-11646 code range.

While the criteria for measuring the reportable size of the excision and the subsequent code to report has changed since then, I have found no other documentation that indicates a change in the coding concept that was discussed. I hope you have found this information useful. :)
 

mitchellde

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Keep in mind the approach that was used for the excision:

From CPT-Assistant August 2000 pages 5-6



"When an excised lesion is a neoplasm of uncertain morphology (eg, melanoma vs. dysplastic nevi), choosing the correct CPT code relates to the manner in which the lesion is excised, rather than the final pathologic diagnosis, since the CPT code should reflect the knowledge, skill, time, and effort that the physician invests in the excision of the lesion.Example: An ambiguous, but low-suspicion lesion might be excised with minimal surrounding, grossly normal skin/soft tissue margins, as for a benign lesion. This would be most appropriately reported using the excision of benign lesion codes 11400-11446. An ambiguous, but moderate-to-high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion. This type of excision would be most appropriately reported using the excision of malignant lesion codes 11600-11646."

Your provider must be specific in the documentation there is moderate to high suspicion
that the lesion may be malignant to justify using the 11600-11646 code range.

While the criteria for measuring the reportable size of the excision and the subsequent code to report has changed since then, I have found no other documentation that indicates a change in the coding concept that was discussed. I hope you have found this information useful. :)
The moderate to high suspicion is used once the path report is received indicating uncertain behavior not prior to path. Just wanted to clarify this.
 
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