# calculating lesion measurements



## nagela

I need to know the correct way to calculate the measurement of lesion removal. I get path reports measurements 4x4x3mm. I not sure I'm calculating it correctly. The total I would come up with 48mm which convert to 4.8cm. Am I calculating the measurements correctly?  I work for a billing company this is for a family practice and the dr doesn't give me any measurement, all I have to go by is the path report.
Thanks,
Amy


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## elenax

I going to refer you to *The Coding Edge of May 2009 *that just came up. There is an article about *'When Measuring Skin Lesions'* that I think you will find very helpful.


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## FTessaBartels

*Measure at widest part plus margin*

Lesions should be measured BEFORE they are excised. Okay ... your surgeon isn't doing that, so you can only go by path.

You take the widest measurement ... If the SAMPLE is 4x4x3mm you have a measurement at its widest which already includes the margins of 4mm.

If the LESION measures 4x4x3mm you have a lesion at its widest of 4mm plus minimal allowable margin, let's say 1mm per side or a total of 2 mm for a grand total of 6 mm. 

Tissue shrinks after it is excised and before the pathologist measures it. Your surgeon is leaving money on the table by not providing you with the measurements in advance of removal.  

ALSO, if repairing the surgical wound requires intermediate or complex closure, this is coded separately and the *length of the repair *needs to be separately documented. 

So, ideally you'd have something like:  Lesion measured 4x4mm with 1mm margins. Length of incision 2cm.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## LCRUZ515

Tessa is very correct. You should never take your measurements from the path report. The tissue shrinks. If your physician had to submit documentation for that excision it would be incomplete documentation. He or she must document the size of the lesion.


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