Dermatology Coding Alert

Question: Our dermatologist saw a patient with lesions on his face and cheek. He excised a 2.6-cm benign lesion on the patient's chin and a 3.1-centimeter benign lesion from the patient's cheek. The physician then closed the wounds with a layered closure. How should I report this visit?

Georgia Subscriber

Answer: For this encounter, you should report three codes. For the lesion excisions, report 11443 (Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 cm to 3.0 cm) and 11444 (... excised diameter 3.1 cm to 4.0 cm). Code the layer closure with 12053 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm).

Why: Most lesion removals require suture closures, and simple closures are included in the surgical package. If the patient's wound requires a layer closure, however, you can report it separately.

How: Report the layer closures by adding the lengths of the two closures together and assigning the appropriate repair code. If the dermatologist completes simple repairs, you should choose from the 12001-12021 series depending on the sum of the length of repairs. For intermediate (layered) repairs, you should also sum the length of repairs for each group of anatomic site and choose from 12031-12057. And for complex repairs, after summing the length of repairs for each group of anatomic site, you should choose from 13100-13160 for reconstructive procedures and complicated wound.

Exception: If the physician excised lesions in different anatomic areas and both required layered closures, you would report two separate codes for the closures. For example, the dermatologist completed two closures. First, the dermatologist completed a 3.0-cm layered closure of a wound on the patient's hand, so you should report 12042 (Layer closure of wounds of neck, hands, feet, and/or external genitalia; 2.6 cm to 7.5 cm). The dermatologist also completed a 2.5-cm layer closure of a wound on the patient's nose, and you would report 12051 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) in addition to 12042.