General Surgery Coding Alert

Tip: Skip margin calculations for 11300-11313 When reporting shaving of epidermal or dermal lesions as described by 11300-11313, you must follow a very different set of rules than when you report more familiar lesion excision codes 11400-11646. More fundamentally, you may not always be clear on when you should select 11300-11313 over the excision codes or, for that matter, a biopsy procedure. Here are the facts you need to discern and properly report shaving procedures. Consider Depth to Distinguish Shaving To differentiate between shaving (11300-11313) and excision (11400-11646), you should consider first and foremost the depth of the removal. Technically, anytime the surgeon removes skin tissue, an "excision" has occurred. But for coding purposes, CPT narrowly defines an excision as involving "full- thickness (through the dermis) removal of a lesion." Shaving, by comparison, involves, "sharp removal ... without a full-thickness dermal excision." In some cases, the surgeon may remove the raised portion of a benign lesion and allow additional lesion tissue to persist in the dermis. "Shaving implies a superficial removal," says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. The surgeon's method to remove a lesion better reveals the difference between shaving and excision. During shaving, the surgeon uses a "transverse incision or horizontal slicing," as CPT notes, to remove the lesion. In this way, surgical shaving resembles shaving to remove body hair. For instance, the surgeon holds the blade horizontal to the skin and moves it across the lesion, literally shaving it off. Often, in fact, the surgeon will use a razor blade to shave a lesion. Excision, in contrast, usually involves holding the blade perpendicular to (and thus cutting through) the skin to remove the lesion at a greater depth -- for which a scalpel is better suited. In these cases, the surgeon always wishes to remove the entire lesion to the greatest necessary depth. "You have to read the documentation carefully," Bishop says. "Physicians may use terms like -shave biopsy- for a procedure CPT might describe as an excision." Bottom line: Pay attention to the removal's depth more than the terminology your physician uses. A final clue that may help you differentiate between shaving and excision is whether the surgical wound required repair, Bishop says. Although excision frequently requires suture or separate repair, shaving "does not require suture closure," CPT says. You-ll see excisions more often: "General surgeons don't do a lot of shave removals," says M. Trayser Dunaway, MD, FACS, CSP, a general surgeon, author and educator with Healthcare Value in Camden, S.C. "We typically will completely excise all smallish lesions because we all get a bit nervous about spreading the tumor by a biopsy. When we excise, we [...]