Primary Care Coding Alert

Question: We have an ongoing discussion in our office regarding how to code for excisions versus shave removals. Two common examples for our practice would be:

• Full thickness shave removal (1 cm lesion on the shoulder plus 3 mm margins) -- with and without sutures placed
• 6 mm punch removal through full thickness (3 mm lesion on the neck) -- with and without sutures placed. Could you recommend how to code each of these scenarios?

Louisiana Subscriber

Answer: CPT bases dermal lesion shave codes (11300-11313) on the lesion size. In your example, of a 1 cm lesion, report 11301 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm). Shave removals don't usually require sutures.

Excision change: If the physician excised the lesion rather than shaved it, base coding on the lesion's size and whether the lesion was benign or malignant. Codes 11400-11446 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), ...) represent benign lesions and 11600-11646 (Excision, malignant lesion including margins, trunk, arms, or legs ...) represent malignant lesions. Simple closure (e.g., with sutures) of the excision site is included in these codes; intermediate or complex closure is reported separately.

Punch removal: Punch removal may reflect either intent to biopsy or excise a lesion. In the case of punch biopsy, the procedure typically involves removal of a portion of the lesion for diagnostic purposes. Punch biopsy codes include 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (...each separate/additional lesion [List separately in addition to code for primary procedure]). Code based on the number of lesions removed rather than the lesion size. In the case of punch excision, the procedure typically involves removal of the entire lesion for therapeutic (rather than diagnostic) purposes. Punch excision would be reported using the skin excision codes noted above, based on the pathology of the lesion and the excised margin.