Practice Management Alert

Question: The physician removed a 0.9 cm benign lesion from a patient’s left leg with a 0.4 cm margin. How should we code this encounter?

Rhode Island Subscriber

Answer: On the claim, report 11402 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 1.1 to 2.0 cm) for the removal.

Explanation: When a provider performs lesion excision, he will remove the lesions as well as margins of healthy tissue around the wound. For your lesion excision claims, you need to add the dimensions of the lesion your provider removes to the margins, and then use that length to determine code choice.

Also, be sure to measure the lesion size before sending the specimen to pathology. Otherwise, the specimen will shrink, and you’ll have to downsize your excision area.

If at all possible, you should wait on the pathology report before coding a lesion as benign or malignant. You could end up miscoding, obviously — but the consequences could be much worse for the patient who the physician misdiagnoses.

Example: You code for a malignant lesion removal without confirmation from the pathology report, and the specimen comes back benign. The patient now has a documented cancer diagnosis, which is not easy to erase from his medical record.

Best bet: Practice patience to protect your patients and your practice. Wait on the pathology report before choosing a lesion excision code. If, for some reason, you must file the claim without pathology, always defer to the benign lesion codes.