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Primary Care Coding Alert

Reader Questions:

Removal Tactic Helps Guide Lesion Coding

Published on Thu Mar 17, 2011

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 SubscriberAnswer: 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 [...]
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