I wouldn't use 11623 and 11643- no where in the procedure note does it give the diameter excised... (lesion diameter plus the most narrow margins required equals the excised diameter- I think you may be getting confused with the 3-0 nylon and 4-0 nylon is a surgical dressing the docs use when suturing the wound) unless the sizes are specified in the path report you have. Otherwise, I would down code these to 11620 and 11640- I'm on the same path as you. The report says 'lesion' not tumor-which are the codes they came up with and that leads me to skin- and since the path report says it was cancer- I would code it as malignant too. Hope this helps!
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