Wiki Lesion w/repair

[Greenpiper]

Need help with a lesion excision w/repair
3 coders each with a different take: Punch biopsy done at previous visit pt came in for lesion excision. As you can see we have all interpreted the guidelines a little differently so we are hoping to get some clarification. Thank you

DX C44.91

(A) 11606 (4cmX2.5cm) (B) 11604 (4cm) provider does not mention margin
12032 (4cmX2.5cm) 12031 (no mention of repair size)

(C) 11604 (4cm) provider does not mention margin
12032 (4cm) based on excision length

Final pathology report:
LT shoulder punch biopsy- basal cell carcinoma, superficial and nodular type. Extends to lateral margin.

Skin Lesion Excision Procedure:

The risks, benefits and possible complications were explained, including the possibility of scar formation, bleeding, and infection. Patient understood and agreed to proceed. The area was then cleansed with iodine, sterily prepped and draped, then anesthetized with buffered 1% lidocaine with epinephrine. The lesion was then excised in an elliptical fashion with a 4cm x2.5cm incision. The lesion was sent to pathology. Double layer skin closure was done with two running 4-0 Vircyl sutures, one in the deep subcutaneous and the ohter subcuticular. skin glue and steri stripes applied. The area was cleaned and a dressing applied. Wound care instructions given.

 

[thomas7331]

If I were coding this report, I would query the provider or have a discussion with them about clarifying the documentation. To code this properly, you need to know the size of the lesion, including any margins, and the length of the closure - you have neither here. I don't know what a '4cm x 2.5 cm incision' means - an incision is usually just one dimensional cut in the skin, not a square, so I don't understand what they mean here. And even so, incision size is not information you use for coding, since it doesn't tell you the dimension of the excised lesions and also doesn't tell you the length of the final repair (both of which can be larger or small than the incision itself).

Given this, your choices above are anybody's guess, although I think your choice A is definitely incorrect, because your code is based on the measurement of the largest diameter - you can't add the two dimensions together for lesion size. 11604 & 12031 is the more conservative choice given the limited information you have but even this can't be validated from the documentation you've have here.

 

[ccditroia@gmail.com]

Hey
Hope this helps
(1) 11604 as per CPT manual the definition it includes the margins 3.1 to 4.0

(2) Per CPT manual sections guidelines it states requiring intermediate or complex closures separately (would be 12031 for this case)
*simple closures are included in the 11604

Christine DiTroia- CPC