5 Coding Tips - Lesion Excision

So many questions...is it benign or malignant, is wound closure included, does the size of the lesion matter, can I report more than one excision at a time? Coding excisions of lesions may seem complicated but if you follow these 5 steps below it should be a breeze. 

  1. Measurements count! When considering what code set to use for excision of a lesion (11400-11646), the size of the lesion that is being excised as well as the width of the margins need to be taken into consideration. Per the CPT book “Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that (most narrow) margin required for complete excision”. As soon as an incision in made into the skin the size of the lesion will reduce in size so it is important that the provider measure the lesion previous to the incision.
  2. Pathology-wait for the report! Because the code set (11400-11646) is based on whether the lesion is benign or malignant it is always recommended to wait until the pathology report is received back before making a selection from the code set. This will also help with the selection of the correct DX code.
  3. Location, location, location! Another factor in selection of the correct code is determined by the location of the lesion on the patient’s body; make sure you are closely reviewing the descriptions of the codes due to the fact that multiple areas of the body are grouped into a single code set.
  4. Repairs-simple repair is already included in the excision code! Simple closure of the wound is bundled into the excision code; therefore simple repair cannot be billed with CPTs 11400-11646. On the other hand, neither intermediate repair (12031-12057) nor complex repair (13100-13153) are included in the excision code and can be billed separately. However, any payer that abides by NCCI edits will bundle these repairs into CPTs for the excision of a benign lesion 0.5 cm or less (11400, 11420, and 11440).
  5. Multiples can be reported separately! If there are multiple lesion the physician is removing each lesion can be coded separate. Keeping in mind to assign a -59 modifier for any lesion reported after the first one.

With these 5 quick tips in mind, coding the excision of lesions whether it be one or multiple, should no longer be a headache.