Outpatient Facility Coding Alert

Reader's Question:

Code 11420 and 11422 Separately for Excision

Published on Mon May 18, 2015

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Question: Our surgeon diagnosed a patient with a verruca formation on the right middle finger, dorsal PIP level, and a smaller nodule formation with a possible verruca to the dorsal right middle finger. He documented excising a large verruca to the right dorsal middle finger at the PIP level with dimensions 6 mm x 6 mm, eclipsing out 1.5 cm x 8 mm x 5 mm. He also excised a small nodular formation to the right dorsal radial middle finger proximal to PIP level at 2 mm x 3 mm x 1 mm. He closed all incisions with sutures. Which code(s) should we report?

Colorado Subscriber

Answer: You’ll code the skin excision at the patient’s dorsal middle finger PIP level with 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm). Link the CPT® code with diagnosis 078.10 (Viral warts unspecified).

To code the second excision of a nodular formation, you’ll submit 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) with diagnosis code 782.2 (Localized superficial swelling mass or lump).

The NCCI edits do not bundle 11420 and 11422 together, so you shouldn’t need to add any modifiers to the claim.