Otolaryngology Coding Alert

Question: How should I code a radical resection of malignant ear melanoma with full-thickness skin graft (FTSG). The excision size measured 4.5 cm, and the FTSG was more than 10 sq cm. Should I use an excision code and also charge the graft harvesting?

Missouri Subscriber

Answer: Yes, you should code the graft in addition to the excision. -When a primary procedure such as ... deep tumor removal requires skin graft for definitive closure, see the appropriate anatomical subsection for primary procedure and this section [15002-15431] for skin graft or skin substitute,- state CPT's Skin Replacement Surgery and Skin Substitutes introductory notes.

Look to 11600-11646 for the malignant lesion excision code (radical resection of malignant ear melanoma). Similar to the graft codes, CPT breaks the excision codes into anatomic and size families. For a 4.5-cm malignant lesion excision from the ear, use 11646 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm).

Graft codes are not exempt from modifier 51 (Multiple procedures). To make sure the carrier pays 100 percent on the higher-valued procedure and reduces payment based on multiple-procedure rules on the lesser-valued procedure, make sure to list the codes in descending relative value unit (RVU) order: 15260, 11646 (with modifier 51 depending on insurer requirements).

Code 15260 contains 23.01 transitional nonfacility total RVUs compared to 12.60 for 11646, according to the 2007 Medicare Physician Fee Schedule.