Otolaryngology Coding Alert

Question: How should I pick the size of the malignant lesion code when my otolaryngologist performs a re-excision after the margins came back positive?

Iowa Subscriber

Answer: The answer depends on whether your otolaryngologist performs the re-excision during the same operative session. When frozen-section pathology shows that the excised margins were inadequate and the physician re-excises the lesion at the same operative session, you should bill one code (11600-11646) based on the lesion's final widest excised diameter. Do not report the original excision in addition to the re-excision.

But, if the doctor widens the lesion's margins at a subsequent operative session, you may bill separately for the re-excision. Thus, you'll have one claim for the original excision and one for the re-excision. Make sure to append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to the lesion code if your physician performs the re-excision during the global surgical period of the primary excision.

To further understand how to code these variations, consider two scenarios that illustrate re-excisions performed during the same and subsequent operative sessions. Suppose your otolaryngologist excises from a patient's lip a lesion with an excised diameter of 0.4 cm. Frozen-section pathology shows the excised margins did not fully remove the malignancy, so the physician re-excises the lesion widening the excised diameter to 0.6 cm. You should report only one code based on the lesion's final excised diameter: 11641 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm).

But suppose the otolaryngologist performs the re-excision on a subsequent day because the pathology report did not come back or was inconclusive. You would report both the excision (11640 excised diameter 0.5 cm or less) and the re-excision (11641) appended with modifier -58 if performed during 11640's 10-day global period.