Internal Medicine Coding Alert

Question: When coding removal of a skin lesion, how do I know whether I should select the benign or malignant code?

New Mexico Subscriber

Answer: You should never "guess" whether a skin lesion the internist removed is malignant or benign. Rather, you should wait for the pathology report to return before selecting the appropriate code. For example, the physician removes a 4.5-cm lesion (including margins) from the patient's left shoulder. Depending on the lesion's status (benign or malignant), the possible code choices include either 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm) or 11606 (Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm). The physician sends the removed lesion to pathology for a determination. Pathology reports that the lesion is benign. You should select CPT code 11406.

-- Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.