General Surgery Coding Alert

Question: The surgeon excised a 1.8 mm warty papilloma in the left nares on the lateral vestibular wall. He then cauterized the base to stop bleeding. Should I report the procedure as 30117 or 11440?

Tennessee Subscriber

Answer: Code 11440 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) does represent lesion excisions, but it isn’t the best choice in this case. You don’t state the results of the pathology report; you should only submit 11440 for benign lesions. The code also includes simple closure, but the cauterization evidently was enough for a lesion so small.

Aside from not knowing the pathology result, your better choice is 30117 (Excision or destruction [e.g., laser], intranasal lesion; internal approach) for another reason — because the lesion was inside the nasal passage. 114xx codes are used for lesions of the integumentary system and this lesion is not a skin lesion because it is inside the nasal cavity.

Physicians can use one of several techniques when performing destruction or excision of an intranasal lesion via the internal approach. In this case the lesion is excised and the resulting defect cauterized.

You would report the same code if the surgeon performed one of the common destruction techniques, such as laser, cryo/ liquid nitrogen, and chemical. Once the lesion is destroyed, antibiotics are applied and the wound is generally left open to heal.