Find out if Lesion Excision Is Included in Advancement Flap Closure
Question: A patient came in for an excision of a forehead lesion. The lesion was surgically excised with appropriate margins, resulting in a defect measuring approximately 6 square centimeters. The specimen was sent to pathology for histologic examination. Due to the size and location of the defect, the provider performed an advancement flap closure measuring 10 sq cm. The pathology results confirmed the specimen as a benign lesion. Should I report 11446 and 14040 for the encounter? Utah Subscriber Answer: No, you won’t assign 11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm) together with 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less) for this procedure. Instead, you’ll just use 14040 to report the encounter. CPT® guidelines that appear before the adjacent tissue transfer or rearrangement codes specify that you cannot report the excision of a benign lesion separately with an adjacent tissue transfer or rearrangement code. Similarly, guidelines before the Excision — Benign Lesions section of codes instructs, “For excision performed in conjunction with adjacent tissue transfer, report only the adjacent tissue transfer code.” The excision of the lesion is included in the adjacent tissue transfer code, so it is appropriate to use 14040 for the excision and advancement flap closure. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
