Wiki 17260 Total Treatment diameter vs. lesion size? HELP

[alpca8631]

Help! I have a dermatology provider who is always billing for malignant destruction lesions. She will document in her note something like this:

The lesion was then prepped with chlorhexidine, and anesthetized with buffered 1 % lidocaine with epinephrine, followed by electrodesiccation and curettage 3 times, achieving 4 mm margins, giving total treatment diameter of 3.3 cm.

I know margins are included per the excision codes (114xx, 116xx) but I have never heard of anyone billing a margin for a destruction (same as a wart)

Is "total treatment area" justifiable as a lesion size or is it only appropriate to bill for the actual size of the lesion only? I'm getting push back from the provider but compliance agrees with us.
CPT assist also states lesion size only and no margins.

Anyone else have any thoughts or solutions

Thanks!

 

[smurf]

Help! I have a dermatology provider who is always billing for malignant destruction lesions. She will document in her note something like this:

The lesion was then prepped with chlorhexidine, and anesthetized with buffered 1 % lidocaine with epinephrine, followed by electrodesiccation and curettage 3 times, achieving 4 mm margins, giving total treatment diameter of 3.3 cm.

I know margins are included per the excision codes (114xx, 116xx) but I have never heard of anyone billing a margin for a destruction (same as a wart)

Is "total treatment area" justifiable as a lesion size or is it only appropriate to bill for the actual size of the lesion only? I'm getting push back from the provider but compliance agrees with us.
CPT assist also states lesion size only and no margins.

Anyone else have any thoughts or solutions

Thanks!

Did you ever get an answer on this?

 

[thomas7331]

I agree with the original post's interpretation above - the CPT description clearly states 'lesion diameter', NOT diameter of the area treated. The addition of margin sizes to the lesion on applies in the excision section of CPT and CPT does not include this in the destruction section, so there would be no justification for adding margins to destruction procedures. For destructions, use the lesion diameter.