# Need assistance - dermatology example



## ccooke9956 (Nov 8, 2012)

I am uncertain how to code this...any help is appreciated.  The pathology came back benign. Biopsy vs 11300 vs 11400 series. Thank you for any assistance


A&P:
1. left abdomen: nevus r/o atypia-scallop excision  .5mm
2. left lower abdomen: nevus r/o atypia-scallop excision .6mm
3. left lat chestwall: nevus r/o atypia-scallop excision .6mm

Histologic analysis are medically necessary. The patient was 
prepped in the usual manner. The lesion was anesthetized with 1% Lidocaine 
and removed by deep scallop technique encompassing a margin of clinically 
normal skin extending into the dermis for biopsy and submitted for 
histologic analysis.


----------



## kb26coder (Nov 8, 2012)

Did the pathology state that the lesions were completely removed and that margins were free/clear? To be able to code for the excision (11400 series), the lesion has to be completely removed and the excision has to extend completely through the dermis to the subcutaneous fat below. Looks like the physician's op note mentions that the cut extends into the dermis, but not sure if it took everything down to the fat or not...any way you could query your doc if he/she did a full-thickness removal? If not, then you would just code for the shave removals.

Hope this helps!


----------



## ccooke9956 (Nov 9, 2012)

Let me be clear....the margins were free and clear.  since he went only into the DERMIS, this would be a shave (11300) and if the went into the subcutaneous this would be a removal (11400)?  The decision on the code is directly related to the depth of the excision, correct? 
Thanks for your time.


----------



## kb26coder (Nov 9, 2012)

If he didn't excise completely through the dermis to the subcutanous fat when removing the lesions, then yes, you would instead code for the shave removals based on size of the lesions and their location...can only charge for the excision when a full-thickness removal is performed.


----------



## ccooke9956 (Nov 9, 2012)

Since I am finally beginning to understand this based on your answers, hope you don't mind a followup question.  Would a biopsy be when they took only a piece of the tissue from the subcutaneous layer and sent to pathology?  If the doc didn't know type of tissue and he took the entire lesion from the subcutaneous layer (clean margins) would this still be considered a biopsy or an excision of an entire lesion, could be malignant or benign depending on path report.
Again, thanks so much, I do appreciate your time.


----------



## kb26coder (Nov 9, 2012)

Yup, a biopsy would be when the doc takes a portion or sample of a larger lesion and sends for pathology. Biopsies can be performed via various techniques (punches, shaves, isis scissors, etc.) so make sure to read your doc's dictation closely...he may say that he performed a "punch biopsy" when he actually did a punch excision. Punch "biopsies" will extend down through the dermis to the subcut fat below so if the pathology comes back as completely excised, he can charge for the benign/malignant excision instead of the biopsy. If the path states that there is tissue remaining, then would charge for the biopsy instead. 

Hope that makes sense!


----------

