Wiki Excision or not?

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vkratzer

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Family practice provider did excision of lesion in office. See below. Would it be appropriate to bill excision of lesion in this case? If not, how would you code it?

O: It is a large, dime-sized area of black hard lesion noted on her mid upper back. With patient's permission, it was cleansed with Betadine solution and anesthetized with 1% Lidocaine with Epi. Using sterile instruments and sterile gloves, the lesion actually from the force of the Lidocaine popped out. It was a hard core, cystic lesion. I then did refresh the edges since it was a large dime-sized area. I did refresh the edges and bring it together and closed it with three 4-0 Ethilon sutures. Hemostasis was obtained with this. Patient tolerated the procedure well.

Thanks for your help.

V. Kratzer
 
Excision

You cannot code based on estimate size of dime. Educate your provider to specify size of lesion in cm rather than dime size. If the patient has never been evaluated for this condition before, then you should also be coding an E/M with 25 modifier based on documentation. The correct excision code would be 11400 since size in cm is not documented.
The best way to handle these would be to wait for lab results and if lesion was malignant, then it would have a different code. Some of us, however, do not have the luxury to wait on the bill, so we use the benign codes when status of lesion is unknown. Of course, it would be better to hold the bill if you can.
 
I keep going back and forth as I am sure you did.. He did refresh the edges which is what leads me to the removal as opposed to a destruction. However you cannot assume the size even though it states "dime" size, if no measurement is given then you must use the smallest size for the area.
also it is not an excision as it does not appear to be below the subq layer or it would not have "popped" out on its own so at best it is a shave. I say 11300
 
scottshar said:
You cannot code based on estimate size of dime. Educate your provider to specify size of lesion in cm rather than dime size. If the patient has never been evaluated for this condition before, then you should also be coding an E/M with 25 modifier based on documentation. The correct excision code would be 11400 since size in cm is not documented.
The best way to handle these would be to wait for lab results and if lesion was malignant, then it would have a different code. Some of us, however, do not have the luxury to wait on the bill, so we use the benign codes when status of lesion is unknown. Of course, it would be better to hold the bill if you can.
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Scott, you cannot bill an excision without a path report. You are not allowed to assume benign. It will more than likely deny anyway as your dx code will not satisfy the payer.. You cannot use a benign dx code, you cannot use 238 code for uncertain behavior you can only use a skin disorder code if you do not have a path report to go by, most payers will deny this for cosmetic. I do not understand when you say you do not have the luxury to wait, If it is an excision you have no choice but to wait. You cannot give the patient a dx they do not have and is not documented and you cannot bill for a procedure that is not documented
 
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