Dermatology Coding Alert

Question:A patient with superficial lesions on his right hand reports to the dermatologist for treatment. The dermatologist shaves off a 0.4 cm lesion with a 0.3 cm margin, and a 0.9 cm lesion with a 0.4 cm margin. How can I account for the margins when I code this encounter?

Texas Subscriber

Answer: You cannot account for the margins. On the claim, report the following:

11306 (Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 cm to 1.0 cm) for the 0.9 cm removal 11305 (... lesion diameter 0.5 cm or less) for the 0.4 cm removal modifier 51 (Multiple procedures) appended to 11305 to indicate that the dermatologist performed two multiple shaves.

Remember: Shaving and excision are two distinct lesion procedures. When the dermatologist shaves superficial lesions, any margins she takes are incidental to the removal; in fact, the physician might not need to take margins when performing these procedures.

Lesion excision codes such as 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less), however, allow margins on the total measurement.