Wiki Billing for Lesion Removal

[kathy a]

My physician always puts the same thing in his lesion removal note. He always bills CPT # 67840, but note always states : The specimen was obtained through sharp excision extending through the dermis into the orbicularis layer. He does give a size in the note, and all visible portions of the lesion are excised. The pathologist note states: Skin, left upper eyelid, shave biopsy with diagnosis of Acrochordon or Hidrocystoma. Generally something benign. He makes no mention of margins, tarsus, and or palpebral conjunctiva. These are done in the office.
It takes me awhile to code these as I 'm not sure if it should be # 67840 or 11440-11446. Any help would be greatly appreciated.

 

[natashalage]

Hello, I hear you.. I was perplexed with documentation also in our practice. Unfortunately, it was not discussed with MDs and I was a junior coder who is still learning on my own. The summary I made:
1. That our MDs are dropping the correct code when they document ' Excisional biopsy" verses 'Incisional biopsy" (but they mean a lesion). We accept their code. Mds are using a template. And now MDs are filing these codes independently.
2. I read that it's more appropriate to code from Eye section CPT than Skin
3. I read that Excisional means 'Entire lesion is removed not a sample =67840. Incisional- removal only a portion of the lesion= 11440-
4. I would code based on OP note and not based on pathology samples.

 

[kathy a]

I think I get thrown off by CPT # 11440-11446 as this is an Excision of other benign lesion including margins. This is a full thickness incision through the dermis around and under the lesion.
The pathology came back as Hidrocystoma which seems to fit the Integumentary code better ? We were always taught to wait for the Pathology report before coding. I am so confused by this.