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The report says excising a 1.5 x 3 cm lesion, which one of those numbers do you use to assign the right code? is the 1.5 width? what about in wounds? if it says a 1.5 x 3 cm wound is the 1.5 width? wounds you code by length right? so it would be the 3?
This has me confused
 
The largest diameter is the size you use, so in your example it would be 3 however do not forget to include the margins.. the codes go by excised diameter not lesion diameter so the physician should be documented either the lesion size and margins or the excised dimensions. so if her said the lesion was 1.5 x 3cm with 1.5cm margins then you double the margin and add to the largest diameter for a total of 4.5 cm. Ihope that helps and does not confuse!
Debra Mitchell, MSPH, CPC-H
 
ok, so if there's a 2 x 3 cm lesion with a 1.5 margin, I would take the bigger number of the 2 x 3 which is 3, and add the margin of 1.5 to it, for a total of 4.5? So I'm coding for 4.5 excised lesion?
what about in lacerations, if they say 1.5 x 2 cm, I know you code by length so which one is length, 1.5 or the 2?
Sorry if i sound so dumb, i'm really not! ive been studying nonstop for 3 weeks for the CPC exam, i think i might be confusing myself more than needed!
 
Draw a picture it always helps ( picture is worth a thousand words!) so if you have a 2cm x 3cm elipse then draw a margin with a 1.5cm distance all the way around, then the largest diameter you have would be the 3, plus 1.5 at the bottom and 1.5 at the top for a total in this scenario of 6cm. remember to double the margin size before you add to the lesion. and Length is always the longer measurement regardless of whether the opening is sideways, vertical or diagonal. And I never got the impression you were dumb. You are making a common mistake and overthinking it. So when you are taking the test draw a picture! Good luck to you, it is not as bad as some say it is.
Debra Mitchell, MSPH, CPC-H
 
Good advice

Debra's advice to draw a picture is great!

In general a lesion is measured at it's WIDEST diameter, PLUS margin (don't forget the margin is doubled). There are several very good illustrations in CPT 2009 Professional edition, pages 53, 54 and 56.

For repairs ... you go by the longest measurement. So whether it's stated as 1.5cm x 3cm -or- 3cm x 1.5 cm the longest measurement is still 3 cm.

I wrote in my CPT book along the top of the page for repairs - "LONGEST" with a red Sharpie so I wouldn't forget.

Good luck!

F Tessa Bartels, CPC, CEMC
 
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