Otolaryngology Coding Alert

Collect an extra $60 or more for complete,full-thickness lesion removals

If you report 11000 every time your otolaryngologist documents a punch biopsy, you could lose more than $60 -- because these services may warrant the higher-paying excision codes.

Don't let the term "punch biopsy" mislead you. Sometimes you should report this procedure as an excision. To distinguish a biopsy from an excision, you should investigate the size and depth of the lesion that he removed and determine why he performed the procedure.

Take the following coding quiz to test your biopsy and excision coding skills:

If your otolaryngologist removes part of a lesion, you should assign a biopsy code, says Pamela J. Biffle, CPC, CCS-P, an independent consultant in the Dallas/Fort Worth area. For a complete removal, you should use an excision code.

Question #1: Apatient presents with a raised, suspicious-appearing 2-mm lesion on her upper-right cheek. The otolaryngologist completely removes the lesion using a 3-mm punch excisional tool and closes the surgery site with one 4-0 ethilon suture.

Coding: In this case, the otolaryngologist removed the entire lesion. You should therefore report the excision code (11440, Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less; or 11640, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less) depending on the pathology report. If the report shows a benign lesion, use 11440. For a malignant lesion, submit 11640.

Be careful: Excision includes simple closure, "So don't separately report the suture," Biffle says.

What if your otolaryngologist fails to document whether he removed part or all of a lesion? You should determine the lesion removal depth. CPT defines an excision as a full-thickness (through the dermis) removal.

Tip: If you find terms such as "full thickness," "subcutaneous" or "through the dermis," you should report an excision (11400-11646).

Question #2: Apatient presents to an otolaryn-gologist's office with a very dark brown, multicolored, irregular-shaped 3-mm lesion on his neck. The surgeon uses a 4-mm punched excision tool to remove the lesion to full thickness. She then closes the site with two 4-0 ethilon sutures in a simple interrupted fashion.

Answer: You should bill a lesion excision. Report 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) if the physician excises a benign lesion or 11620 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) if she performs a malignant lesion excision, recommends Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.

Why: The otolaryngologist excised the entire lesion to the defined depth (full thickness), Cobuzzi explains.

Correct coding tip: Research the operative report to determine why the physician performed the procedure. Otolaryngologists excise lesions to remove the entire piece, but physicians take biopsies to obtain diagnostic specimens (this helps them decide whether they should take further action at the lesion site). The completeness and depth of the lesion removal -- not the method (for instance, punch, scalpel, etc.) -- determines whether the physician performed a biopsy or lesion excision.

Question #3: An otolaryngologist sees a patient with rough skin on her chin. She says that the area looks similar to her prior squamous cell carcinoma, so the surgeon takes a 3-mm punch biopsy of the tissue. He then closes the site with one 4-0 ethilon suture in a simple interrupted fashion.

Solution: You should use a biopsy code (11100, Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion), Cobuzzi says.

Reason: The otolaryngologist took the tissue sample to obtain a diagnosis, not to remove the entire lesion.