General Surgery Coding Alert

Question: Our surgeon excised two subcutaneous lipomas from a patient’s forearm, each requiring separate incisions. The sizes were 4 cm x 3.5 cm and 2.2 cm x 2.6 cm. Should we code this as two separate benign lesion excisions — 11404 and 11403, or add them together to report 11406?

Louisiana Subscriber

Answer: Because the surgeon excises two distinct lesions, you should separately report the procedure code for removing each one. However, 11403-11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 2.1 to …over 4.0 cm) is the wrong code family for these excisions.

Here’s why: Codes 11403-11406 are in the integumentary section and describe excision of benign skin lesions. The surgical report describes subcutaneous lipomas, which are benign fatty tumors that occur in the soft tissue below the skin.

Do this: Instead of the 11400 series, you should select the appropriate soft-tissue tumor codes from the musculoskeletal section. Because the lesions are on the forearm and are subcutaneous, you should code as follows:

• 25071 — Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greater
• 25075 — Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm.

Caution: You’ll need to append modifier 59 (Distinct procedural service) to 25075, because it is listed as a column 2 code with 25071 in Medicare’s Correct Coding Initiative (CCI) edits. Because your surgeon performs these two procedures at distinct surgical sites, you can unbundle the codes.