General Surgery Coding Alert

Question: When the surgeon shaves multiple lesions in the same general area -- the patients face, for example -- should I add the sizes together or report each lesion treatment separately?

Wyoming Subscriber

Answer: You should not add the lesion sizes together. Instead, you should report each lesion treatment separately.

Why? The descriptors for 11300-11313 specify single lesion, which means that you may report one code for each lesion that the surgeon removes by shave technique. If, for instance, the physician shaves 16 dermal lesions, you may report an appropriate code for each shaving. Keep in mind, however, that if the physician does shave an extraordinary number of lesions during a single session, you may have to submit documentation to explain the situation.

Example: Your surgeon removes, by shaving, four dermal lesions: one on the left upper arm, measuring 1.0 cm, two on the chest, measuring 1.4 cm and 1.6 cm, and another on the neck, measuring 0.4 cm.

In this case, you would report 11301 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm) for the upper arm lesion, two units of 11302 (& lesion diameter 1.1 to 2.0 cm) to describe shaving of the chest lesions, and one unit of 11305 (Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less).

Payer differences: Some payers might prefer that you list each removal as a separate line item, with modifier 59 (Distinct procedural service) appended to the second and subsequent identical codes. In the example, this means you would report 11301, 11302, 11302-59, and 11305. Keep in mind that some payers may also require modifier 51 (Multiple procedures), and apply a multiple-procedure discount as well, on claims involving multi-lesion shaving.