#1




Claculation of the diameter of skin excision.
Hi:
Can any one help me to find out the diameter of the excised skin. The doctor has documented that he has excised a bening lesion 2.0 x 1.1 x 0.8 cm. Also kindly tell me if there is any formula to find out the diamenter for the lesions docmented in the above mentioned dimension format. Thanks, Prasad. 
#2




You use the greatest measurement of the diameter (distance across the lesion) and you add to that the margin required for complete excision (determined by the physician). If the physician does not document a margin, simply use the greatest measurement given. In this case, you would use a diameter of 2.0 cm.

#3




Calculation of the diameter of skin excision.
Hi:
Thank you Steve & Jackie for you guidance. Kinldy explain the dimension 2.0 x 1.1 x 0.8 cm. Is 2.0 is the real diameter of the lesion alone nad 1.1 & 0.8 is the length of the margins. Also if the patient had muliple lesions on the same anatomical area (Eg:Trunk) and all the lesions were excised. Can we sum up all the diameter and code or should we code each lesion seperately with modifier 59. Thanks & Regards, N. Mohana Prasad. 
#4




Quote:
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Debra A. Mitchell, MSPH, CPCH 
#5




It took a lot of searching to find where the notes came from but is was from Medical Newswire issue 11/7/05...sorry it took me so long....J.
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Jackie, CPC Choose a job you love, and you will never have to work a day in your life. ~Confucius~ 
#6




Agree with Debra
I agree with Debra on this one. The guideline for measuring the size of lesion is spelled out in CPT (2009 professional edition, page 54 bottom of 1st column): "lesion diameter plus the most narrow margins required equals the excised diameter." (emphasis added by FTB)
Unless the physician specifies the margin I cannot assume what is the most narrow margin required. And furthermore, the size of the excisional wound may be quite a bit larger than this "excised diameter" to allow for appropriate closure. Look at the diagram in CPT 2009 professional edition on page 54, top of lefthand column. The lesion itself is 2.0 cm. The margin is 0.2 cm. But the length of excision (the long oval dotted line), is easily twice the length of the lesion itself. You cannot assume, you cannot use a standard formula. The physician must specify. The appropriate margin will be different for a benign lesion vs a malignant lesion. And the location of the lesion, and type of closure required will further complicate this. I educate my physician's to state "lesion measuring LxWxD; excised diameter with margins x cm; resulting in excisional wound of Y length" (That's how I educate them; they don't always comply.) Hope that helps. F Tesssa Bartels, CPC, CEMC Last edited by FTessaBartels; 11152009 at 05:48 AM. 
#7




Quote:
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Susan Ward, CPC, CPCH, CPCI, CPCD, CEMC, CPRC AAPCCA Board of Directors 20142015 Region 7  Mountain AAPC Expert ICD10 Trainer susan.ward@aapcca.org Together we can change the world, one good deed at a time. 
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