General Surgery Coding Alert

Question: The op report identifies a 1.5 cm basal cell carcinoma diagnosed by prior biopsy that the surgeon “removed.” I’m unclear if the removal is by destruction or excision. How should I code this?

Arkansas Subscriber

Answer: When the op report describes “removal,” of a specific size lesion, the procedure is an excision.

Difference: Excision and destruction are two different approaches to treatment of basal cell carcinoma, although excision is far more common. Excision means that your surgeon removed tissue to eliminate the cancer and submits the tissue for pathologic diagnosis. Destruction describes a different method used to obliterate the cancer cells without removing a specimen for pathologic diagnosis. Because basal cell carcinoma is a malignancy, you need to choose the excision or destruction codes accordingly.

For the lesion excision, you’ll choose a code such as 11602 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm). CPT^® provides 18 codes in the range 11600-11646 to choose from, depending on the malignant lesion anatomical site and excised diameter (size). You should not use a code from the range 11400-11446 (Excision, benign lesion including margins, except skin tag …), which describe benign lesion excisions.

Destruction: If the op report had described using a method such as laser ablation to destroy the cancer cells, you would choose a code from the range 17260-17286 (Destruction, malignant lesion …). For a basal cell carcinoma, you should avoid codes in the range 17000-17004 (Destruction … premalignant lesions…), because those are for lesions determined to be premalignant.

For medical necessity: Don’t forget to add the appropriate anatomically specific code from C44.- (Other and unspecified malignant neoplasm of skin) using the most specific location to describe the neoplasm.