General Surgery Coding Alert

Question: Last month you answered a reader question about coding malignant lesion excisions [Measure Lesion and Excision For Proper Coding, General Surgery Coding Alert, Vol. 21, No. 12], but I have a follow-up question. If the surgeon uses a large elliptical excision for a malignant lesion, should we count that dimension as the margin when determining size for the excision code selection?

Tennessee Subscriber

Answer: No, you should not use the measure of an elliptical margin to select the appropriate malignant lesion excision code.

Do this: You should use the narrowest margin times two in addition to the lesion diameter for the lesion size that guides the excision code choice.

Here’s why: Using the narrowest margin considers the margin that is necessary to remove the lesion, not the incision necessary to close the wound. When the surgeon uses an elliptical margin for closure, don’t use the long elliptical margin as the margin measurement for the lesion excision code.

Loss: If the surgeon doesn’t record a minimum margin in the procedure note but only documents the elliptical incision, you shouldn’t include a margin measurement, only the lesion diameter, to determine the proper code, and that means you stand to lose some pay for the procedure.