General Surgery Coding Alert

Question: Our surgeon performed a scar revision procedure on the patient’s right forearm that involved excising a large existing scar. The excision created a defect of 14.3 sq cm that the surgeon closed with a Z-plasty. Can we report 11406 for the excision and 14021 for the rotation flap?

Georgia Subscriber

Answer: No, you should not report both 11406 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm) and 14021 (Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm) for the surgeon’s work in this case.

You should report only 14021 for this case. Recall that the adjacent tissue transfer codes include both the primary and secondary defects — the defect created by the lesion excision is included in determining the size for the code.

Although it is appropriate to report a benign-lesion excision code such as 11406 for a scar excision, you should not list any lesion-excision code in addition to a code for adjacent tissue transfer or rearrangement.

Here’s why: The CPT^® instructions for benign-lesion excision codes state, “For excision performed in conjunction with adjacent tissue transfer, report only the adjacent tissue transfer code (14000-+14302). Excision of lesion (11400-11446) is not separately reportable with adjacent tissue transfer.” Coders sometimes get confused on this point because CPT^® instructions for 11400-11446 also state, “Repair by intermediate [12031-12057] or complex [13100- +13153] closure should be reported separately.” But a Z-plasty is not an intermediate or complex closure, it is an adjacent tissue rearrangement procedure.

Tip to remember: Lesion-excision codes include simple closure, don’t include intermediate or complex closure, and are included in adjacent tissue transfer or rearrangement.