# HELP!!! Excision of skin lesions...



## kdr4079 (Aug 21, 2008)

Hello, 

I do not have occasion to code derm very often. I have a report with two lesions excised. One is most definitely benign and the physician has indicated cpt 11422. This one is no problem. However he also indicated cpt 11621 but the path results on this lesion is as follows, "The more ulnar lesion appeared to be actinic keratosis or possibly low grade squamous cell carcinoma in situ." What is the appropriate action in this case? I feel that I can't code 11621 since this is not definitely malignant. Would I include the measurements for this suspicious yet not definitely diagnosed lesion in the benign excision codes? 

Any help is greatly appreciated. 

Kim


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## Treetoad (Aug 21, 2008)

I agree with you, Kim.  I wouldn't charge for the removal of a malignant lesion based upon the information you have.  The provider isn't giving you a definite diagnosis.  Is there a path report you could check?  That should give you a definitive diagnosis to work with.


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## kdr4079 (Aug 21, 2008)

*OMG!!! I got a definitive answer*

Thanks for the pointer Treetoad! That was the tip I needed. The section in question did have a SCC, so I can use 11621. Now I can post this and get it off of my desk!

Have a fantastic day and thanks again for the help.


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## FTessaBartels (Aug 21, 2008)

*STOP ... Possible SCC is NOT SCC*

KIm,
In your original post you state that the *path results on this lesion ... appeared to be actinic keratosis or possibly low grade squamous cell carcinoma ...*   - emphasis added by me on the word "possibly."

"*Possibly*" is *NOT* definitive.

F Tessa Bartels, CPC, CPC-E/M


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## elenax (Aug 22, 2008)

I agree with FTessa; I would'nt code for malignant because of the path wording for  'appeared' and 'possibly' is not definitive to support a malignant code.   and if i'm not mistaken we are supposed to wait for the path results to pick the correct CPT.  Any other feedback???


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