Internal Medicine Coding Alert

Question: I'm aware of a "rule" regarding lesion excision and closure charges that I am quite sure I've seen in writing, but I can't find it in CPT®. The rule is that if the size of a lesion is 0.5 cm or less, we cannot also charge for an intermediate repair code. Is that true, and if so, where is it written?

Ohio Subscriber

Answer: You aren't missing anything in CPT® -- Medicare's Correct Coding Initiative (CCI) holds the answer.

CCI bundles the following lesion excision codes and their corresponding intermediate repair code, with the repair code as a column 2 code:

• 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter 0.5 cm or less) and 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less)
• 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) and 12041 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less)
• 11440 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) and 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).

On the other hand, the corresponding intermediate repair codes aren't bundled with the following excision codes, or other excision codes for lesions larger than 0.5 cm:

• 11401 (... excised diameter 0.6 to 1.0 cm) not with 12031
• 11421 (...excised diameter 0.6 to 1.0 cm) not with 12041
• 11441 (...excised diameter 0.6 to 1.0 cm) not with 12051.

Malignant is different: Keep in mind that the intermediate closures are not bundled with the malignant lesion excisions of 0.5cm or less.