Oncology & Hematology Coding Alert

Question: One of our plastic surgeons removed 10 benign masses measuring between 3 and 5 cm each from a patient’s arm. The wound was closed with interrupted sutures of 5-0 moncryl and running closure of 5-0 nylon. The total area of closure was approxi­mately 40 cm.

I’m thinking of reporting:

11404 x 2
11406 x 8
13121

Would this be correct?

AAPC Forum Participant

Answer: Coding this encounter as 11404 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm) x 2, 11406 (… excised diameter over 4.0 cm) x 8, and 13121 (Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm) would not be correct for a number of reasons.

For the excisions: Billing 11404 x 2 with 11406 x 8 might be correct, but if the lesions your provider removed are in the subcutaneous tissue or deeper, you may have to use one or more codes from 24075 (Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm), 24071 (… 3 cm or greater), 24076 (Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm), or 24073 (… 5 cm or greater).

For the closures: Billing 13121 on its own is definitely incorrect, for two reasons. First, the code on its own only reflects repairs up to 7.5 cm. Your provider repaired 40 cm of excisions, which means you should add seven units of +13122 (… each additional 5 cm or less (List separately in addition to code for primary procedure) to 13121.

More, the information you provide does not clarify what complexity the closure meets. If the closure is simple or intermediate, the correct codes would be 12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm) or 12037 (Repair, intermediate, … ; over 30.0 cm).

Remember: CPT^® guidelines indicate “When multiple wounds are repaired, add together the lengths of those in the same classification (see above) and from all anatomic sites that are grouped together into the same code descriptor.” So, if different complexity of closure is performed, you would report a mixture of repair codes.