You Be the Expert: Lesions and Complex Closures

Test your knowledge.  Determine what you would do in this situation before looking at the box below for the answer.
 
Question: The Ambulatory Care Center in which I work recently saw a patient who needed removal of two lesions, one of which required a complex closure. What is the correct way to code for these procedures? Is the closure included in the code for removal or does it require an additional code? I assume that each excision is coded separately.

Georgia Subscriber

 









Answer: CPT codes for the excision of benign lesions (11400-11471) or the excision of malignant lesions (11600-11646) include payments for simple, nonlayered closure. However, when repair requires intermediate or complex closure, repair codes should be reported in addition to the excision code. 

An intermediate closure (12031-12057) is defined as a layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia in addition to the skin closure. Complex closures (13100-13133) involve more layers and additional techniques such as scar revision or retention sutures. The depth and location of a wound, the thickness of skin involved and the length of the repair all contribute to its complexity. 
 
The size of the lesion also determines the correct CPT code and might affect additional coding for complexity of the closure. For example, 11400 (excision, benign lesion, except skin tag [unless listed elsewhere], trunk, arms or legs; lesion diameter 0.5 cm or less), 11420 (& scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less) or 11440 (& face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less) include payment for simple, intermediate or complex repairs. However, the excision of benign lesions greater than 0.5 cm in diameter or the excision of any size malignant lesion never includes payment for intermediate or complex repairs.

 
In the case of multiple excisions requiring simple repairs, code the excision of each lesion separately. When the closures are more complex, add the length of the closures together and bill one repair. The excision of multiple lesions should also be coded separately.


- Published on 2001-07-01