# Help with excision, please?



## renifejn (Dec 4, 2009)

I've been asked to review some Dermatology cases recently and can't seem to
> remember the coding for it as I've only ever had to do it on tests.  I'm
> hoping somone can help me out on this.
>
> For the first nevus would it be 3.2+1.8=5cm(CPT 11406) or is just taking
> the
> largest size (3.2cm/11404)?
>
> Pt presents for excision of two nevi on the buttock and abdomen..
>
> Physical exam revealed a 14 X 12 mm brown velvety plaque on the right
> abdomen and a 22 X 9 mm plaque on the right buttock..
>
> Written consent was obtained after discussing the risks and benefits of the
> procedure. The chest and buttock were prepped with Hibiclens. Anesthesia 10
> mLs. lidocaine 1% with epinephrine was injected into the site. After the
> procedure 3 mls of 1/4% marcaine with epinephrine was injected into the
> wounds.
>


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## mitchellde (Dec 6, 2009)

You take the largest diameter for your excision size.  From your op note convert from mm to cm and code each excision separate according to the largest diameter.  You will need a 59 modifer and it will go on the smaller of the excisions since they are in different sites of the same grouping.


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## FTessaBartels (Dec 9, 2009)

*Write this in your CPT book*

Across the top of the page(s) for lesion excision (BOTH benign and Malignant) write - DO NOT ADD DIMENSIONS - EACH LESION CODED SEPARATELY

Across the top of the page(s) for wound repair write - ADD SAME SITE, SAME CLASS TOGETHER AND CODE ONCE

So for your patient with two nevi on the buttocks and abdomen you will have a total of 3 codes IF INTERMEDIATE REPAIR
1140x for largest of the two nevi
1140x-59 for the smaller nevus
1203x-59 for the intermediate repair (add the lengths of the two incisions together)

Hope that helps.

F Tessa Bartels, CPC, CEMC


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