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Shaving and Excision of lesions

  1. #1
    Default Shaving and Excision of lesions
    Medical Coding Books
    I need to have some clarification on how to correctly code a shaving of a lesion and an excision of a benign lesion; I think I'm getting confused on how to calculate the lesion size.

    shaving of lesion (back) measures .7 x .5 x .3 mm and 1mm margin was made around lesion

    punch biopsy of lesion (back) measures 4mm x 4 mm --removed with 5mm punch biopsy

    thanks for any input and advice

  2. #2
    I was told to add them together when I did derm clinic but I did find this so I hope it helps you!

    The code selection depends on the reason for removal. Removal of a lesion by shaving, codes 11300–11313 (differentiated by body area and lesion diameter), may be reported for lesions that require only superficial removal, such as a benign-appearing nevus on a body area subject to trauma. Biopsy codes 11100–11101 should be reported when the intent is to obtain tissue to send to pathology (e.g., biopsy of a suspicious lesion using shave technique). Codes for excision of benign lesions (e.g., 11400–11471) or malignant lesions (e.g., 11600–11646) should be reported for full-thickness removal (through the dermis), including margins.

    To get the correct number, I found this example. To determine the total excised diameter, calculate the lesion diameter at its widest point (the crucial measurement under the old guidelines) plus the width of the margin at its narrowest point.

    For example, the surgeon excises an irregularly shaped, malignant lesion from a patient's left shoulder. The lesion measures 1.5 cm at its widest. To ensure removal of all malignancy, the surgeon allows a margin of at least 1.5 cm on all sides. In this case, add the size of the lesion (1.5 cm) and the width of the narrowest margin (1.5 cm top, 1.5 cm bottom) for a total of 4.5 cm (1.5 + 1.5 + 1.5 = 4.5). Therefore, the appropriate code is 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm).

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Default Principles of CPT Coding
    Here is some information from the book titled " Principles of CPT Coding" ( I live by this book).

    Shaving of Epidermal or dermal lesions:

    Codes 11300-11313 are reported on teh basis fo the anatomic area and the size fo the lesion. When choosing a code, the first step is to pick the appropriate group of codes that includes the anatomic area where the lesion is located. For example, codes 111305-11308 are for lesions located on the scalp, neck, hands, feet and genitalia. Next, the size of the lesion is chosen on the basis of the lesion diameter.

    Example: Lesion on the leg measuring 1.2 cm in diameter is removed by shave technique. Because the lesion is located on the leg and has a diameter of 1.0 cm, code 11301 woudl be reported.

    Excision of lesions:

    Excision is defined as full-thickness ( through the dermis) removal of a lesion, including margins, and includes simple ( non layered) closure when performed. Report separately each a benign lesion excised. Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision ( lesion diameter plus the most narrow margins equals the excised diameter). The margins refer to the narrowest margin required to adequately excise the lesion, based on teh physician's judgment.
    Roxanne Thames CPC, CPC-I, CEMC

    "Remember the greatest gift is not found in the store but in the heart of true friends"

  4. #4
    Milwaukee WI
    Default Check documentation carefully
    To answer your questions specifically ....

    You take the widest diameter, and add the narrowest margin TWICE (i.e. margin on each side of the lesion.

    Your first example is listed as 7 x 5 x 3 mm w/ 1 mm margin ... 7 + 1 + 1 = 9 mm, which is translated to 0.9 cm
    (At least I think it's 7 mm ... is there a decimal point in front of each of these numbers because that will DRASTICALLY change the math)

    Example two is a 4mm lesion ... no margins are listed, though he states he used a 5 mm punch. It really doesn't make a difference because the smallest dimension is 0.5 cm or less, and either of these numbers fit this category.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Question confused
    So I have a physician that states he did a "shave biopsy" even if he put the size of the lesion it's still coded as the 11100. Does it matter if it is a part of it or the whole lesion.
    Kim Whiston CPC

  6. #6
    Columbia, MO
    Quote Originally Posted by kimmie45601 View Post
    So I have a physician that states he did a "shave biopsy" even if he put the size of the lesion it's still coded as the 11100. Does it matter if it is a part of it or the whole lesion.
    It willdepend on the note, if he takes only a piece of the lesion then it is a biopsy, if it describes that he removes the entire visible anomaly to a depth of partial thickness (into but not through the dermal layer) then it is a shave.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default Excision of benign lesion
    Need a calulation of a benign excision of the shoulder when the note only states 4mm x 5mm. Another one is 6mm and another is 4mm x 6mm is all that is in the note. Thank You!!

  8. Default
    I also have that issue - the doctor just documented size of lesion 1.5 by 1.3 cm. Do I take the biggest number 1.5 as the diameter and add it .6 + .6 (.6 was the margin)?

    Also, he notes "an incision through the dermis into the subcutaneous fat was made". Do I code the excision code from the Integumentary System or a code from the Musculoskeletal System? If the latter, which codes do I look at?

    Thank you so much!!

  9. #9
    Any help for above?

    I have one that "measures 18 X 7 mm."

    DR is charging 11602. Path came back cancerous.

    Any help appreciated.

  10. Default Check your path report
    I just found some measurements on the path report.

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