Dermatology Coding Alert

Question: When coding removal of a skin lesion, how do I know if I should select the benign or the malignant code?

Texas Subscriber

Answer: You should never guess whether a skin lesion the dermatologist removes is malignant or benign. Rather, you should wait for the pathology report to return before selecting the appropriate code.

For example, the dermatologist removes a 4.5-cm lesion (including margins) from the patient's left shoulder. Depending on the status of the lesion (benign or malignant), the possible code choices include either 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm) or 11606 (Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm).

Your dermatologist sends the removed lesion to pathology for a determination. Pathology reports that the lesion is benign. You should select CPT code 11406.