Otolaryngology Coding Alert

Question: I’m coding for two separate malignant lesions on the scalp. Do I add both lesion sizes together and report one code? Do I use the same approach for coding the repair?

Arizona Subscriber

Answer: If your physician excises or repairs multiple lesions of the same anatomical site, you add the size of the lesions for a single code on your claim. The malignant lesion excision code choices for the scalp are:

• 11620 – Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
• 11621 – … excised diameter 0.6 to 1.0 cm
• 11622 – … excised diameter 1.1 to 2.0 cm
• 11623 – … excised diameter 2.1 to 3.0 cm
• 11624 – … excised diameter 3.1 to 4.0 cm
• 11626 – … excised diameter over 4.0 cm.

Unlike repair codes, lesion excisions are not added together to come up with the appropriate code for multiple lesions that are excised.  Each unique lesion is coded separately.  Lesions excised from like anatomical areas would have the 59 modifier (Distinct procedural service) appended (or the XS modifier for Medicare) for each separate lesion.

Example: Let’s say the surgeon excised two malignant lesions from the patient’s scalp. One was 0.8 cm in excised diameter and the other was 1.1 cm. He also removed a 0.4 cm malignant lesion from the patient’s nose. Those code choices are:

• 11640 – Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less
• 11641 – … excised diameter 0.6 to 1.0 cm
• 11642 – … excised diameter 1.1 to 2.0 cm
• 11643 – … excised diameter 2.1 to 3.0 cm
• 11644 – … excised diameter 3.1 to 4.0 cm
• 11646 – … excised diameter over 4.0 cm.

The example scenario would be coded as 11622, 11621-51, and 11640-51.