Ob-Gyn Coding Alert

If coders use the 1142x series, the size of the lesion(s) must be indicated. The size of the lesion is chosen based on the lesion diameter, and if more than one lesion is excised, each lesion should be reported separately.

For instance, if one wart was 1.0 cm in diameter and another was 1.5 cm in diameter, the claim would read 11422, 11421-51 (Multiple procedures) (note that the highest-valued code is always listed first on the claim form). However, if the two warts are side by side and are removed through one incision, the code that represents the total area removed for the "double" wart is used, in this case 11423 (1.0 + 1.5 = 2.5 cm).

The size of a lesion is measured by its clinical diameter for a circular or elliptical lesion. The diameter is the length of a straight-line segment that passes through the center of a figure, especially of a circle or sphere, and terminates at the periphery.

If the lesion is asymmetrical or irregular, the maximum width is used to measure the lesion. The physician should make an accurate measurement of the lesion at the time of the excision, and the size of the lesion should be documented in the operative report.

To use 56605 and 56606, you need not document the size of the lesion or lesions. But these codes also describe excising the lesion for biopsy, and therefore would be the codes of choice if this were the purpose of the procedure rather than therapeutic removal of the lesions.

The relative value unit (RVU) for 11421 is 3.48 if the procedure is done in the office, but only 2.48 if done in the hospital. The RVU for 56605 is 3.11 if done in the office, 1.71 in the hospital.

For 56606, the RVU is 2.30 for each additional lesion removed in the office setting or .84 if done in the hospital.