Stop Undervaluing Excisions: Here’s How

Look beyond 116XX, or suffer reduced accuracy and reimbursement
When your surgeon performs lesion excisions, don’t forget that you may be able to access the musculoskeletal codes (20000-series), or you could seriously undercut your reimbursement for these procedures.

Depth Provides a Guide for Best Excision Code

When you report an excision procedure, such as a lipoma (fatty tumor) removal, consider reporting either the codes for benign lesion excision (11400-11471) or those for musculoskeletal soft-tissue excision.
Your code choice depends on the excision’s depth and, just as importantly, the specificity of the surgeon’s documentation, says Jeffrey Weinberg, MD, director of the Clinical Research Center, Department of Dermatology at St. Luke’s-Roosevelt Hospital Center in New York City.
Guideline: If the surgeon’s incision does not go deeper than the fascia, the conservative choice is the appropriate code from CPT’s "Integumentary System" section (11400-11471), although the excision needn’t necessarily reach the fascia to qualify as a musculoskeletal procedure in all cases (see "Something else to consider," at right).
Example: If the surgeon’s documentation specifies, "Full-thickness excision of 2.5-cm lesion (with margins) from left shoulder with simple closure," the appropriate code choice is 11403 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 2.1 to 3.0 cm: APC 0020).
In this case, both the term "full-thickness" (that is, "through the dermis") and "simple closure" should tip you off that the required incision was not very deep.
"During ‘full-thickness’ excisions, the surgeon removes all layers of skin, and possibly even some subcutaneous tissue, but this does not mean that you should select a musculoskeletal code," says Terri Brame, CPC, CPC-H, principal at BEST Coders. "The excision doesn’t extend into the musculoskeletal soft tissues, it just extends to them."

Incision Isn’t Always Skin Deep

If the excision goes deeper than the fascia, the removal is definitely not superficial, and the musculoskeletal codes are more appropriate, Weinberg says.
Important: Your surgeon’s documentation must be explicit to support using these codes and should specifically note the incision’s depth.
Example 1: If the surgeon’s documentation notes a subcutaneous tumor, you may report 23075 (Excision, soft-tissue tumor, shoulder area; subcutaneous: APC 0021) for removal of lipoma (fatty tumor).
For even deeper incisions (subfascial or intramuscular), you may choose 23076 (Excision, soft-tissue tumor, shoulder area; deep, subfascial, or intramuscular: APC 0022), Weinberg says.
Example 2: The surgeon notes that he excised a subcutaneous tumor from the patient’s neck. In this instance, the term "subcutaneous" provides evidence that you should report 21555 (Excision, tumor, soft tissue of neck or thorax; subcutaneous: APC [...]

- Published on 2008-07-08