ED Coding and Reimbursement Alert

CPT breaks codes into 6 size categories.

There are three categories for lesion removal coding, confirms Yvonne Mayer, CPC, senior coding analyst at Bill Dunbar and Associates in Indianapolis.

- Report 11400-11446 (Excision, benign lesion including margins - ) for "excision of benign lesions of various sizes and anatomical locations," reports Mayer.

- Report 11450-11471 (Excision of skin and subcutaneous tissue for hidradenitis -) for excision of skin and subcutaneous tissue prompted by hidradenitis -- an inflammation of a sweat gland that can be a chronic supportive disease and may produce scarring of the skin and subcutaneous tissues, Mayer says.

- Report 11600-11646 (Excision, malignant lesion including margins ...) for excision of malignant lesions of various sizes and anatomical locations.

CPT also groups the benign and malignant excision codes in three anatomical areas:

- trunk, arms, or legs (11400-11406 for benign lesions, 11600-11606 for malignant lesions);

- scalp, neck, hand, feet, and genitalia (11420-11426 for benign lesions, 11620-11626 for malignant lesions); and

- face, ears, eyelids, nose, lips, and mucous membrane (11440-11446 for benign lesions, 11640-11646 for malignant lesions).

"The three anatomical categories are further broken down into six different size classifications," Mayer says. The sizes range from 0.5 cm or less to more than 4.0 cm.

Example: The ED physician removes a benign 1.3 cm lesion from a patient's neck. On the claim, you would report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm) for the service.