Primary Care Coding Alert

Removal of lesions or growths is among the procedures family physicians perform most frequently in their offices. Common or not, however, this area of coding is considered a minefield by many coding experts because a variety of factors must be considered if the practice hopes to receive optimum reimbursement.

Three categories of codes are most often used when documenting lesion removal shaving, excision and destruction and each carries its own set of complications. Some coders may consider biopsies (11100-11101) as part of this category but, by definition, a biopsy is only a partial removal of tissue or fluid for diagnostic purposes, not complete elimination.

When to Use Shaving Codes

The simplest of the three methods of lesion removal is shaving, which is performed on superficial lesions like moles or other growths that do not appear to penetrate the fat layer, according to Emily Hill, PA-C, president of Hill & Associates, a coding and compliance firm in Wilmington, N.C. Coding for these procedures is included in the 11300-11313 series, depending on the location and size of the lesion (e.g., 11300*, shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5. cm or less or 11311, shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm).

These codes would be assigned if the physician is certain that removal will be very simple and that there is little chance of bleeding or any other sort of complication, she says. Use of local anesthesia is also included in the code.

Because of the nature of the procedure, there would be no need for a suture closure or reporting a repair code.

Hill cautions that shaving codes may mistakenly be reported for other simple procedures. Sometimes these are assigned when paring or cutting codes would be most appropriate (CPT 11055, paring or cutting of benign hyperkeratotic lesion [e.g,. corn or callus]; single lesion; 11056, two to four lesions; and 11057, more than four lesions). Coders need to remember that the paring codes are specifically for corns and calluses, and that the shaving codes would not be correct in these instances.

The same holds true for the removal of skin tags, she adds, which is reported with 11200* (removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions) and add-on codes CPT 11201 (each additional ten lesions [list separately in addition to code for primary procedure]).

Coding for Excision

Excision is the removal of a growth by cutting through the tissue and removing the entire lesion, Hill says. It may include local anesthesia, as well as simple suturing to close the wound. CPT codes assigned for [...]