# Lesion with Complex Repair



## BABS37 (Mar 25, 2014)

Hi. I'm just learning more about dermatology coding and documentation and wanted to see if anyone can clarify the report below. I've always been taught to never code by the procedure title only and I don't think the documentation supports the measurements listed. 

Can someone tell me what they think?

Procedure:
Excision of central lip lesion measuring .05 cm CPT 11440
Complex repair upper lip measuring 1.1 cm CPT 13151

A #15 blade was used to incise the previously made lines, including both the lesion and the margins as well as inferior and superior burow triangles. The lesion was sent to Path. Hemostasis was achieved with bipolar cautery. THe wound was widely undermined with a #15 blade for 1 cm in all directions. The wound was closed in a multilayered fashion with deep inverted sutures.


----------



## jholt12 (Apr 4, 2014)

Hello,
after looking at your note it doesn't look like you would be able to code a 13151. The only way to code a complex closure if it was 1.1 and larger. The body of the note says 1 cm so I wouldn't code a 13151.

Thanks


----------



## BABS37 (Apr 23, 2014)

Ah perfect! I didn't think the documentation supported 13151 either.


----------



## pinkfloyd1 (Apr 23, 2014)

Widely undermining is an indicator of a complex closure.


----------



## BABS37 (Apr 24, 2014)

Hi pinkfloyd1! I know widely undermining is an indicator of a complex closure but the actual documentation in his dictation says the repair only measured 1 cm in all directions so that's why I don't think 13151 is appropriate to bill as the description starts at 1.1 cm. Is this not how you interpret the procedure done? I just don't like coding from headings as I don't think that's appropriate...


----------



## AB87 (Apr 24, 2014)

Ive coded many Exc and Repairs and you are right that you shouldnt code from the heading, but the procedure note in this case would be ok to Bill 13151 (IMO). If you feel its conflicting you should query the Provider if the 1 cm is really a complex repair. From my Exp i wouldnt question the type of repair unless its missing certain details, But i do see your point of view because it does say 1cm then 1.1cm in the heading. You could downcode to 13150 for 1.0cm and Less


----------



## CatchTheWind (Apr 25, 2014)

13150 is a discontinued code as of this year.  The new rule for complex closure codes is that they can only be used for repairs of 1.1 cm or greater.  If the repair is 1.0 cm or less, you have to use an intermediate repair code, regardless of the undermining done.


----------



## AB87 (Apr 25, 2014)

Well that shows how long its been since ive touched a Derm Note lol.


----------

