Urology Coding Alert

Question: I have a question regarding removal of a penile lesion. I found two code choices: 11424 and 54060. I’m not sure which is appropriate because the descriptors for both state “excision.” Can you explain why I should select one code over the other?

Wisconsin Subscriber

Answer: Whether you should report 11424 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm) or 54060 (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; surgical excision) depends on the type of lesion the patient has.

You should use codes 54050-54065 (Destruction of lesion[s] …) for removal of penile lesions such as condyloma, papilloma, molluscum contagiosum, or herpetic vesicles (as stated in the definition of these codes). However, for other skin lesions such as sebaceous or epidermal cysts, benign or other skin lesions, you should choose a code from the 11420 (Excision, benign lesion …) series of CPT^® codes.

Bottom line: Check your provider’s documentation for guidance. If you are still unsure which code is most appropriate, your physician should be able to tell you the type of lesions he removed – which will point you toward the correct code.