Reader Question:
Too Small for Intermediate Closure
Published on Thu Mar 15, 2012
Question:
I'm aware of a "rule" regarding lesion excision and closure charges that I am quite sure I've seen in writing, but I can't find it in CPT®. The rule is that if the size of a lesion is 0.5 cm or less, we cannot also charge for an intermediate repair code. Is that true, and if so, where is it written?Ohio Subscriber
Answer:
You aren't missing anything in CPT® -- Medicare's Correct Coding Initiative (CCI) holds the answer.
CCI bundles the following lesion excision codes with their corresponding intermediate repair code as a column 2 code:
- 11400 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter 0.5 cm or less) with 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less)
- 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) with 12041 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less)
- 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) with 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).
On the other hand, the corresponding intermediate repair codes aren't bundled with the following excision codes, or other excision codes for lesions larger than 0.5 cm:
- 11401 (... excised diameter 0.6 to 1.0 cm) not with 12031
- 11421 (...excised diameter 0.6 to 1.0 cm) not with 12041
- 11441 (...excised diameter 0.6 to 1.0 cm) not with 12051
Malignant is different:
Keep in mind that the intermediate closures are not bundled with the malignant lesion excisions of 0.5cm or less.