Practice Management Alert

Question: Can we report a lesion excision (116xx) with a layered closure?


Florida Subscriber

Answer: When the surgeon performs a layered closure to repair a lesion excision site, depending on the lesion excision's size, you may not be able to report the closure separately at all.

Excision codes 11400-11446 (benign) and 11600-11646 (malignant) describe full-thickness (that is, through the dermis) lesion removal with margins and include simple (nonlayered) closures (12001-12018). As CPT instructs, however, -The closure of defects created by incision, excision or trauma may require intermediate or complex closure. Repair by intermediate or complex closure should be reported separately.-

Warning: Medicare and other payers that follow the Correct Coding Initiative (CCI) do not adhere to CPT guidelines and instead bundle even layered closures for small wounds.

Specifically, CCI bundles intermediate (12031-12057) and complex (13100-13153) repairs to excision of benign lesions of 0.5 cm or less (11400, 11420 and 11440), as demonstrated in the chart below. But Medicare does not bundle intermediate and complex repairs of malignant lesion excision wounds of 0.5 cm or less. Medicare believes there's very little medical necessity for doing a deeper closure for such a small benign lesion excision, whereas you may need to go deeper for even small malignant lesions.

Example: The surgeon removes three lesions from a Medicare patient (0.5 cm, benign with complex repair on the patient's right arm; 0.5 cm, malignant with intermediate repair on the left leg; and 2.0 cm, benign with complex repair on the left arm).

You can't claim separate closure for the first lesion because it is 0.5 cm or less in size and is benign. You can claim separate closure for the second excision, even though it is 0.5 cm or less, because it is malignant. And you may report complex repair separately with the final excision because the benign lesion measures greater than 0.5 cm.

Check yourself: For this case, you should report the following:

- 13120 (Repair, complex, scalp, arms and/or legs; 1.1 to 2.5 cm) for the complex repair of the 2.0-cm benign lesion on the left arm

- 12031 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) for the complex repair of the malignant lesion

- 11600 (Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 0.5 cm or less) for the 0.5-cm malignant lesion excision on the left leg

- 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 2.0-cm benign lesion excision on the left arm.

- 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) for the 0.5-cm benign lesion excision on the right arm. Note that you cannot separately code the complex repair for this lesion.

The answers to the Reader Questions were provided and/or reviewed by Barbara J. Cobuzzi, MBA, CPC, OTO, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders, the coding organization in Salt Lake City.