"To report the removal of skin lesions, the method of removal, size and location of the lesion, and whether the tissue was benign or malignant are the crucial elements needed to select the proper CPT code . There may be variation, however, among local payers regarding the modifiers that are used for reporting the removal of multiple lesions. |
Three Methods of Removal
There are numerous types of skin lesions and a variety of ways to remove them. But there are three methods of removal that internists primarily employ:
1. Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal or dermal lesions without a full-thickness dermal excision, according to CPT. The descriptions of the codes for shaving (11300-11313) all include local anesthesia and chemical or electrocauterization to close the wound.
2. Excision is defined as the full-thickness (through the dermis) removal of a lesion, according to CPT. Local anesthesia and a simple (non-layered) closure are included in the descriptions of both the excision of benign lesion codes (11400-11446) and the excision of malignant lesion codes (11600-11646).
3. Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement. This could include electrosurgery, cryosurgery, laser or chemical treatment. Lesions that might be removed in this manner include condylomata, papillomata, molluscum, contagiosum, herpetic lesions, warts, milia, or other benign, premalignant (e.g., actinic keratoses) or malignant lesions. Local anesthesia is included in the description of the codes for the destruction of benign or premalignant lesions (17000-17250) and malignant lesions (17260-17286). No wound closure is necessary with this type of removal.
Maximum Width Reported as Size
The size of a lesion is measured by its diameter, states the fall 1995 issue of CPT Assistant . The diameter is the length of a straight-line segment that passes through the center of a figure, especially of a circle or sphere. If the lesion is asymmetrical or irregular, the maximum width can be reported as the size of the lesion, says Carol Ethridge, CPC, coding specialist at Baptist Health Centers, a practice management group for more than 75 medical practices in Birmingham, Ala.
If the dimension of the lesion is 3x4x5 cm, you would go with the highest measurement, which would be 5 cm in this case, she explains. Its only the lesion itself that is measured, even if the internist does remove some of the skin surrounding the lesion.
Because reimbursement is higher for larger lesions, it is important that the measurement of the lesion be taken from the patients medical record and not the pathology report, says Kathy Pride, CPC, CCS-P, coding supervisor for Martin Memorial Medical Group, a multispecialty physician group in Stuart, Fla. Lesions that are shaved or excised are sent to the pathology lab for analysis…
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