Lesion removal

Worxs43

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Hello Everyone,
How would you handle the following as I'm not sure the code the provider has added is correct.
Provider went with cpt 11302 but I'm seeing 17110 see it as destruction by any method, benign lesion.


PROCEDURE NOTE After discussing the procedure and risks, including but not limited to bleeding and infection, verbal and written consent was obtained from the patient.
Pre-procedure diagnosis: inflamed sebker
Post-procedure diagnosis: SameProcedure:

Shave biopsy The lesion was anesthesized with 2 ml 1% lidocaine with epi. It was prepped with betadine and draped. A 15 blade was used to shave the lesion at the skin surface The resulting wound was cauterized with silver nitrate/monsels. Good hemostasis was noted. The patient tolerated the procedure well, and there were no complications noted. The patient was warned of the possibility swelling and bleeding and was asked to call with any unexpected problems. He was instructed to keep the area clean and dry and to apply antibiotic ointment daily for 5-7 days. Bactroban as ordered.
 

csperoni

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I think you're both incorrect, but I haven't coded derm in a number of years.
You're missing the word "biopsy" on the procedure note here. I would not code a destruction (17110) as you suggested. I would not code 11302.
Due to "Procedure: Shave biopsy", I would look at 11102-11107. 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
That's my 2 cents, but would appreciate derm coders chiming in to confirm or debunk my suggestion.
 

trarut

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I also haven't coded derm in quite some time but agree with Christine on this. I would also code it as a biopsy using 11102.
 

Worxs43

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Hello,
Thanks for the response. That's what I was thinking as well the 11102 but for biopsy you would take a piece of the lesion Dr removed the whole lesion.
 

csperoni

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Hello,
Thanks for the response. That's what I was thinking as well the 11102 but for biopsy you would take a piece of the lesion Dr removed the whole lesion.
I'm not a clinician, but if the doctor writes "biopsy", then that is what I code. Nothing in the information provided would indicate otherwise. Based on the documentation, 11302 would not seem correct as it indicates biopsy and not removal. There is also nothing mentioned about the size which would be required for 11302. How do you know the physician removed the whole lesion? If 11302 is what actually was performed, then the documentation needs correction.
 

Worxs43

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I'm not a clinician, but if the doctor writes "biopsy", then that is what I code. Nothing in the information provided would indicate otherwise. Based on the documentation, 11302 would not seem correct as it indicates biopsy and not removal. There is also nothing mentioned about the size which would be required for 11302. How do you know the physician removed the whole lesion? If 11302 is what actually was performed, then the documentation needs correction.
Good Evening Csperoni,
Thank you.
 
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It states: shave biopsy, but if you read farther down it sounds like the dr. shaved the whole lesion off. So, in that case your Dr. is correct with 113- series if the measurements match up correctly. You may ask if he performed a Tangential Technique which uses a sharp blade to obtain the biopsy.

The physician removes a biopsy sample of skin or subcutaneous tissue for the purpose of performing a diagnostic histopathologic study under a microscope. Skin biopsies are reported based on one of three techniques used: tangential, punch, or incisional. Tangential technique describes a biopsy performed via a sharp blade to obtain a superficial, epidermal tissue specimen that may or may not include sections of underlying dermis and does not involve a full-thickness biopsy. Punch technique involves the use of a specific punch tool to obtain a full-thickness, barrel-shaped, or columnar-shaped specimen. Simple closure, including any manipulation of the biopsy defect, is included in the performance of a punch biopsy. The incisional biopsy technique describes a biopsy utilizing a sharp blade (no punch tool) to obtain a full-thickness specimen via a wedge or vertical incision. This technique type may involve specimens of subcutaneous fat. Closure of an incisional biopsy, other than simple closure, is reported separately. Report 11102 for a tangential biopsy, initial lesion; each additional lesion, report 11103. Report 11104 for a punch biopsy, initial lesion; each additional lesion, report 11105. Report 11106 for an incisional biopsy, initial lesion; each additional lesion, report 11107.
 

Worxs43

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Good Evening pwebbabshire,
Thank you for your response. Yes I queried the provider and found that she did go on to completely remove the lesion so she gave the sizing filing with code 11302. :)
 
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