Wiki Biopsy removal/Cpt coding

[TLC]

I'm confused when a doctor removes eg: a 7mm lesion for biopsy on the arm, however the total area of the diameter "cut" out is 3cm to make sure all possible cancer is removed how would that be coded? ......11601 for the 7mm lesion plus 3mm margins,,, or 11603 for the total diameter of the cut. Thanks

 

[FTessaBartels]

Measuring lesion

The measurement of the lesion needs to be taken by the physician BEFORE excision. A lesion is measured at it's widest diameter PLUS narrowest margin needed for complete removal.

Please see the guidance and drawings in the CPT manual (2011 Professional Edition, published by AMA, page 62. You see that the lesion is 0.2 cm, the excised diameter is 0.4 cm, but the length of the elliptical excision (makes the whole thing look like the drawing of an eye) is MUCH longer (probably 1.0 cm).

The length of the incision may be (and usually IS) considerably longer to allow for closure. This separate measurement must also be given so that layered closure can be appropriately coded (if performed).

You should ask the doctor whether the 7mm measurement includes the narrowest margin; if not, you need to know what the narrowest margin is ... AND the physician needs to amend his documentation to reflect that.

Hope that helps.

F Tessa Bartels, CPC, CEMC