Coding Corner: Refresher Course: Sharpen Your Lesion Removal Coding

Take this quiz to see if your skills are up to par

Are details about lesion removal procedures on the tip of your tongue? Ace this quiz to get them back on the claims.
Question 1: Sometimes the physician removes lesions, sends them to pathology, and they come back as malignant - but because the edges are not clear, he has to remove more tissue. Should we bill that initial procedure as just a biopsy?
Answer: No, says Donna Dantzler, RHIA, CCS-P, CCA, CCS, coding specialist program coordinator and CPT instructor at Trident Technical College in Charleston, S.C. If the doctor's intent was to remove the entire lesion, and he did the work, you can report it.
"He tried to remove that whole thing, not just take a piece of it.  So, you can still code for the excision even if it came back with positive margin," Dantzler says.
Tip: When the physician goes back to remove the additional margin, sometimes the new sample will come back from the lab as benign. In this case, you can still use the malignancy code, because the first part came back as malignant.
Question 2: I've been hearing contradictory advice on how to measure lesions for removal. Should I include the margins? Should I measure the lesion before or after sending the sample to pathology?
Answer: CPT guidelines tell you to determine the total excised diameter by calculating the lesion diameter at its widest point, plus twice the width of the margin at its narrowest point.
Example: The doctor excises an irregularly shaped, malignant lesion from a patient's left shoulder. The lesion measures 2.5 cm at its widest. To ensure removal of all malignancy, the surgeon allows a margin of at least 1.5 cm on all sides. In this case, add the size of the lesion (2.5 cm) and double the width of the narrowest margin (1.5 cm + 1.5) for a total of 5.5 cm (2.5 + 1.5 + 1.5 = 5.5). Therefore, you should report 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm).
The correct time to measure the lesion is prior to excision. The pathology report will not provide an accurate measurement because lesions shrink when placed in formaldehyde. Relying on the pathology report will mean smaller measurements - and consequently, loss in compensation.

Similarly, often the excision site will be larger than the actual incision if the edges of the wound are under tension.
Question 3: How are lesion removal codes divided? What distinctions should I be looking for?
Answer: In terms of excision, CPT breaks down lesion codes by [...]

- Published on 2005-06-20