Otolaryngology Coding Alert

Coding all services involved in a lesion removal can quickly lead you into "gray" areas, such as determining whether you should report a separate E/M service when performing minor excisions in the office.

Use these three case studies to understand how you should handle confusing lesion coding scenarios. Compare your answers with our experts' on page 83.

Scenario 1: A family physician (FP) refers a patient to your ENT for excision of a "mole" on the patient's left cheek. The ENT suspects that the mole is a small basal cell carcinoma (which is later confirmed by pathology).

She performs an excision to remove the lesion, which measures 0.9 cm with margins, in the office. She then closes the wound via simple repair and releases the patient. How should you report this?

Scenario 2: The FP refers the patient to the ENT for a skin lesion removal from the forehead. This time, however, the ENT views the lesion as potentially more serious and not diagnosable by simple exam. The ENT performs a thorough exam and biopsy to determine the nature of the lesion. The biopsy returns positive for malignancy, and the ENT schedules the patient for excision at a later date in the operating room (OR). How should you report this?

Scenario 3: The ENT suspects squamous cell carcinoma on the cheek and excises the lesion in the office. The pathology report returns later showing positive margins -- meaning that the ENT did not remove all the malignancy and must excise additional tissue. The ENT schedules an additional excision for wider margins in the OR and takes a frozen section. This time the pathology report returns negative. How should you report this?