ED Coding and Reimbursement Alert

Question: A patient presents to the ED with several lesions on his upper body. The physician excises all the lesions with simple closures. The pathology report reveals the facial lesions are malignant and the neck and chest lesions are benign. The lesions, with margins, of the face measure 2.5 cm. The lesion on the neck measures 0.8 cm. and the lesions on the chest measure 3.2 cm. How many lesion repair codes should I report for this encounter?

Minnesota Subscriber

Answer: You will report three lesion removal codes for your physician's services. On the claim, report the following:

• 11643 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm) for the malignant facial lesion removals
• 173.3 (Other malignant neoplasm of skin; skin of other and unspecified parts of face) appended to11643 to represent the patient's malignant facial lesions
• 11404 (Excision, benign lesion including margins, except skin tags [unless listed elsewhere], trunk, arms or legs; excised diameter 3.1 to 4.0 cm) for the chest lesion removals
• 216.5 (Benign neoplasm of skin; skin of trunk, except scrotum) appended to 11404 to represent the patient's chest lesions
• 11421 (Excision, benign lesion including margins, except skin tags [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm) for the neck lesion removals
• 216.4 (... Scalp of skin and neck) appended to 11421 to represent the patient's neck lesions
• Modifier 51 (Multiple procedures) appended to 11404 and 11421 to show that the benign lesion removals were separate from the malignant lesion removals.

Remember the margins: When coding the removal of the lesion, remember to include the margin excised in the total removal area. Take the margin dimensions from the physician notes - not the pathology report. If you use the pathology report to measure the total removal area, you'll be shortchanging the practice. Remember, the storage fluid will shrink the tissue, which would result in an inaccurate measurement.