Measuring and Coding Removal of Lesions

hugstrees

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I am coding the removal of a benign skin lesion of the right leg. The EXCISION measured 1.5 x 3 cm. The margin size was not documented in the chart note and thus would be considered already included in this measurement. Would the CPT be 11402 or 11403?
A second question, if the lesion itself measured 1.5 x 3 cm plus margin of 0.2 cm. Would the total excised diameter be 3.4 cm with the correct CPT being 11404?
Thank you for clarifying. :)
 

CodingKing

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According to the guidelines..... Code selection is determined by measuring the greatest clinical diameter.

1.5 x 3 cm with no documentation of the margins is considered 3 cm (greatest diameter) or CPT 14003

1.5 x 3 cm plus margin of 0.2 cm would be considered (.2 | 3 | .2) or 3.4 cm in diameter or CPT 14004
 
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hugstrees

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Another Question

Thank you, Code King, for the previous response. I have an additional question for you or anyone out there. When billing an elliptical incision that is 4 cm long by 2.5 cm wide, is it incorrect to bill for a 4 cm lesion? A question has been raised as to this being fraudulent.
Thank you.
 

thomas7331

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When billing an elliptical incision that is 4 cm long by 2.5 cm wide, is it incorrect to bill for a 4 cm lesion?

That would be incorrect - the lesion excision code is chosen based on the excised diameter of the lesion plus the margins, not based on the length of the incision. These are two different things. The size of the lesion is the size of the tissue that was removed. The size of the incision is the length of the cut that is made in order to access the lesion.
 
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hugstrees

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Excision done in office

Is 11772 Excision of pilonidal cyst or sinus, complicated billable in office setting? AND does anyone know where I can find information as to what is billable in office and what is not? Thank you.
 
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