ED Coding and Reimbursement Alert

Question: The physician excised a 2.7-centimeter tumor on a 34-year-old male outpatient. How should I code this scenario, and are there any diagnosis codes that payers tend to look for when reviewing these claims? Michigan Subscriber Answer: It depends on the state of the tumor and in what anatomic site the tumor is located. For a benign tumor, you would report one of the following codes, depending on the tumor's location:

11403 - Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter 2.1 to 3.0 cm
11423 - Excision, benign lesion including margins, except skin tag, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
11443 - Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm. If the tumor is malignant, though, you would report one of the following codes:

11603 - Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm
11623 - Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
11643 - Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm