ED Coding and Reimbursement Alert

Question: A patient with a growth on the side of his face presented in the ED. The physician stated that the lump appeared to be an inclusion cyst. Under local anesthetic, the physician made an incision. Nothing was drained, but the documentation said the appearance is "fish-meat-like," and the doctor performed a wide excision. She then removed the growth, and sent it to pathology to rule out basal cell carcinoma. The preliminary results: keratoacanthoma. Which CPT code should I report?

New Jersey Subscriber
 
Answer: The first issue you need to resolve is whether the lesion is benign or malignant. For excision of benign lesions, you should consider the code set 11400-11471, and choose the appropriate code based on the anatomic location and size. Keep in mind that size, here, is defined as the greatest clinical diameter of the lesion plus the margin required for complete excision.
 
These code sets also include simple closure of the wound. If the lab ultimately finds the lesion to be malignant, you would report the appropriate code from the 11600-11646 series. Check the final pathology to see if the lesion was ultimately determined to be benign or malignant, because keratoacanthoma is a pseudocarcinoma - a conditions that is usually not invasive but "masquerades" like a cancer.