How to Code for Skin Lesion Excision and Repairs?
Ensure accurate skin lesion excision coding with proper CPT® and ICD-10-CM codes, based on lesion type, location, size, and pathology report for optimal reimbursement.
Dermatology Billing & Coding Alert
Accurate coding for skin lesion excisions is crucial for ensuring proper documentation, billing, and reimbursement in healthcare. Understanding the coding process helps healthcare professionals, providers, and coders navigate the complexities of determining the appropriate codes based on specific parameters. The skin, the body's largest organ, serves not only as a protective barrier but also as a sensory organ vital to human interaction. Coding for excisions requires careful attention to the lesion's location, type (benign or malignant), and the procedure performed.
Key Questions for Accurate Skin Lesion Excision Coding
To ensure precise coding for skin lesion excision, it’s essential to gather information from the documentation that answers the following three key questions:
- Was the lesion benign or malignant?
- Where was the lesion located (anatomic site)?
- What was the excised diameter of the lesion?
These questions guide the selection of the correct CPT® and ICD-10-CM codes, ensuring accurate reporting for reimbursement and compliance.
Let’s explore how these parameters are defined and how they influence your code selection.
How to Code for Skin Lesion Excision and Repairs?
Follow these general guidelines for precise coding and billing practices:
Excision of Skin-Origin Tumors
- For benign subcutaneous tumors confined to the fatty layer beneath the skin, use the CPT code series for skin and subcutaneous excisions (11600-11646).
- For malignancies like melanoma that extend deeper, the skin and subcutaneous code series, rather than the musculoskeletal series, should also be used.
Re-Excisions
- Same Operative Session: Use a single code based on the widest excised diameter for additional excisions performed in the same session.
- Different Operative Session: For re-excisions in subsequent sessions to widen margins, continue with codes from the 11600-11646 series.
- During Postoperative Period: When performed in the postoperative period, append modifier 58 to the relevant excision code.
Pathology Report
- Always rely on the pathology report for accurate classification.
- If the report is not available, use an unspecified diagnosis and assign a benign excision CPT® code (11400-11471).
Repairs and Adjacent Tissue Transfers (ATT)
- Simple repairs are included in excision codes, while intermediate or complex repairs should be coded separately.
- When ATT is performed, the excision is not coded separately.
Determine Location
Report each skin lesion excision separately based on its anatomical location using the following classifications:
- Benign Lesions:
- Trunk, arms, legs: Codes 11400-11406
- Scalp, neck, hands, feet, genitalia: Codes 11420-11426
- Face, ears, eyelids, nose, lips, mucous membrane: Codes 11440-11446
- Malignant Lesions:
- Trunk, arms, legs: Codes 11600-11606
- Scalp, neck, hands, feet, genitalia: Codes 11620-11626
- Face, ears, eyelids (skin only), nose, lips: Codes 11640-11646
Calculate Lesion Size
When coding for skin lesion excisions, the size of the lesion plays a critical role in code selection. According to CPT® coding guidelines, the excised diameter is determined by measuring the greatest clinical diameter of the lesion plus the margin required for complete excision. The margin is defined as the narrowest area needed to remove the lesion fully.
Here’s how you calculate the excised diameter:
- Excised diameter = Lesion size + (2 x margin size)
For example, if the lesion measures 1 cm and the surgeon removes a 0.5 cm margin on all sides, the total excised diameter would be 2.0 cm (1.0 cm + [2 x 0.5 cm]).
Applying Classification, Location, and Size for Proper Coding of Skin Lesion Excision
Once you have gathered the key facts—classification, location, and size—you can accurately determine the appropriate CPT® code for skin lesion excisions. Here are two examples illustrating how to use this information to select the correct code:
Example 1: Malignant Lesion Excision
- Classification: Malignant lesion (confirmed by pathology report).
- Location: Right shoulder (classified as trunk, arms, or legs).
- Size Calculation:
- Lesion measures 1.0 cm at its widest.
- Surgeon removes a margin of 1.0 cm on all sides.
- Total excised diameter = 1.0 cm (lesion size) + (2 x 1.0 cm margin) = 3.0 cm.
Correct Code: 11603
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm.
Example 2: Benign Lesion Excision with Uncertain Behavior
- Classification: Neoplasm of uncertain behavior (per pathology report).
- Location: Left cheek (classified under the face, ears, eyelids, nose, lips, mucous membranes).
- Size Calculation:
- Lesion measures 1.5 cm at its widest.
- Surgeon removes a margin of 0.5 cm.
- Total excised diameter = 1.5 cm (lesion size) + (2 x 0.5 cm margin) = 2.5 cm.
Correct Code: 11443
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm.
Multiple Excisions Require a Modifier
When multiple lesions are excised, each excision must be treated as a separate procedure. A unique diagnosis should be linked to each individual CPT® code. To prevent claims denials due to duplication, you should append modifier 59 (Distinct Procedural Service) to the second and all subsequent codes describing excisions at the same anatomical location.
Example: Multiple Lesions on the Left Arm
A surgeon removes three lesions from the left arm. The lesions have the following excised diameters:
- Lesion 1: 0.5 cm (benign)
- Lesion 2: 1.5 cm (benign)
- Lesion 3: 2.0 cm (malignant)
Proper Procedure and Diagnosis Coding:
- Malignant Lesion:
- Code: 11602
- Excision of malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm
- Diagnosis: 173.6 Other malignant neoplasm of skin, skin of upper limb, including shoulder
- Benign Lesion (1.5 cm):
- Code: 11402-59
- Excision of benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 1.1 to 2.0 cm
- Diagnosis: 216.6 Benign neoplasm of skin; skin of upper limb, including shoulder
- Benign Lesion (0.5 cm):
- Code: 11400-59
- Excision of benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 0.5 cm or less
- Diagnosis: 216.6 Benign neoplasm of skin; skin of upper limb, including shoulder
Key Points
- Modifier 59 is applied to the second and subsequent codes for excisions in the same location.
- Proper documentation and coding of lesion size and location ensure accurate reimbursement and prevent denials.
Lesion Excision Bundling Concerns
When reporting skin lesion excision (CPT® codes 11400-11646), it’s important to be mindful of bundling issues, especially when other procedures are performed at the same anatomical location during the same session.
Do Not Report in Addition to Lesion Excision
- Local anesthesia (This is included in the lesion excision codes)
- Simple closures (CPT® codes 12001-12018) — These are bundled into the excision code.
Report in Addition to Lesion Excision
- Intermediate repairs (CPT® codes 12031-12057) and complex repairs (CPT® codes 13100-13153) — These can be reported separately if performed in addition to excision.
- Reconstructive closure (CPT® codes 15002-15261, 15570-15770) — These may be reported if reconstructive procedures are performed.
Do Not Report in Addition to Lesion Excision
- Anesthesia and Pain Management (CANPC) — These are typically bundled and not reported separately.
- Adjacent tissue transfer (CPT® codes 14000-14350) — This is also considered part of the excision procedure and should not be reported in addition.
Mastering the Reporting of Skin Lesion Excision in Five Steps
Accurately reporting the excision of benign (11400-11471) and malignant (11600-11646) skin lesions requires a clear understanding of key coding principles. Following these five steps simplifies the process, ensuring precision in medical billing and compliance.
Here are the 5 steps:
Step 1: Measure First, Cut Second
For CPT® codes 11400-11646, accurate reporting requires knowing the size of the lesion and the width of the surrounding margins that are excised. According to CPT® guidelines, code selection is based on the largest clinical diameter of the lesion plus the narrowest margin needed for complete excision. Measuring the lesion and margins before excision is essential, as the lesion may shrink once the skin tension is released during the procedure.
Step 2: Wait for the Pathology Report
Before assigning CPT® codes for lesion excision, it is essential to confirm whether the lesion is benign or malignant, which can only be determined by the pathology report. Lesions identified as malignant may be coded with a malignancy-specific code, while benign lesions require different coding. However, if a re-excision is performed later to obtain clear margins, you can use the same malignant diagnosis linked to the initial excision, as the reason for the re-excision is related to malignancy.
Step 3: Location Matters
The anatomic location of the excised lesion is crucial for selecting the correct CPT® code. It is important to refer to the specific code descriptors, as some areas are grouped together and may share a common set of codes.
Step 4: Bundle Simple Repairs with Excision
According to CPT® guidelines, simple wound closure is included within the excision codes for lesions. While intermediate (12031-12057) and complex (13100-13153) repairs can be coded separately, those performed on benign lesions of 0.5 cm or less (codes 11400, 11420, 11440) are typically bundled with the excision, in line with National Correct Coding Initiative (NCCI) edits.
Step 5: Report Each Lesion Separately
When multiple lesions are excised during the same procedure, each lesion must be reported separately with its own CPT® and ICD-10-CM code. For excisions in the same anatomical location, append modifier 59 (Distinct procedural service) to the second and subsequent excision codes.
Example 1: A surgeon excises a lesion from the right shoulder that measures 1.5 cm in diameter, with a 1.5 cm margin on all sides. The total excised diameter is 4.5 cm. The pathology report identifies the lesion as malignant. The correct code is 11606, for excision of a malignant lesion with an excised diameter over 4 cm, located on the trunk, arms, or legs.
Example 2: A surgeon removes three lesions from the right arm. Two lesions are benign (1 cm and 1.5 cm in diameter), and one lesion (2.5 cm in diameter) is malignant. The malignant lesion is coded with 11603, and the benign lesions are coded with 11402-59 and 11401-59, using modifier 59 for the second and third excisions.
Trust BillingFreedom For Coding and Billing for Skin Lesion Excision and Repairs
BillingFreedom is the best choice for accurate and efficient dermatology medical billing and coding of skin lesion excision and repairs. With a deep understanding of CPT® coding guidelines, we ensure precise code selection based on lesion classification, location, and size.
Our team excels at handling both benign and malignant excisions, considering the lesion’s diameter and margin requirements to guarantee proper code assignment. We also manage complex cases involving multiple excisions, using modifier 59 to prevent denials for procedures at the same anatomical location.
In addition to excision coding, BillingFreedom ensures compliance with bundling rules, avoiding unnecessary claims for services already included in the excision, such as local anesthesia and simple closures.
We accurately report additional services like intermediate and complex repairs, ensuring you receive the proper reimbursement.
Trust BillingFreedom to handle your skin lesion excision and repair billing with the utmost expertise and accuracy, minimizing rejections and maximizing revenue.
For more information on how we can support your practice, feel free to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472.
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