Coding guidelines for Excision of skin lesion

Coding guidelines for Excision of  skin lesion 

1. If the lesion removal requires dressings, strip closure, or simple closure, these services are not separately reportable
2.      12001-12021 (Simple repairs) are integral to the lesion removal codes
3.   Intermediate or complex repairs, adjacent tissue transfer, and grafts may be separately reportable if medically reasonable and necessary.
4.     Removal of one lesion smaller than 0.5 cm does not preclude also reporting an intermediate or complex repair for a larger lesion.
5.     Excision of benign lesions with excised diameter of 0.5 cm or less. Includes simple, intermediate, or complex repairs which shall not be reported separately.
6.     Excision of lesion should be larger than 0.5 cm then only intermediate or complex repairs  can be coded Debridement of non-viable tissue surrounding a lesion, incision, or injury to complete the procedure, the debridement is not separately reportable.

How to calculate excision of skin lesion?

Excised diameter its widest point + narrowest Margin *2

–     Exmaple:  A surgeon excises benign skin lesion from a patient’s left arm.  Prior to excision, the lesion measures 1.5 cm at its widest and margin of at least 1.5 cm 

                  size of the lesion (1.5 cm) + margin (1.5 cm x 2 = 3                          cm)  =  total of 4.5 cm

What is the Margin?

                   The portion of healthy tissue around the lesion also excised

Multiple lesions at same site

If multiple lesion treat separately in same site should be coded all lesion separately with 59 modifier

    Example: Three lesions, all from the left arm, with sizes 1 cm (benign), 1.5 cm (benign), and 2.5 cm (malignant)

You should report: 11603, 11402-59, and 11401-59

Can we code Excision of lesion with ATT

• Lesion removal may require closure (simple, intermediate, or complex), adjacent
  tissue transfer, or grafts. If the lesion removal requires dressings, strip closure, or simple closure,
  these services are not separately reportable.
• Thus, CPT codes 12001-12021 (Simple repairs) are integral to the lesion removal codes. Intermediate or complex repairs, adjacent tissue transfer, and grafts may be separately reportable if medically reasonable and necessary. However, excision of benign lesions with excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440) includes simple, intermediate, or complex repairs which shall not be reported separately
• If more than one lesion is removed and one of those lesions is larger than 0.5 cm, an intermediate or complex repair may be reported, if performed, for a lesion larger than 0.5 cm. Removal of one lesion smaller than 0.5 cm does not preclude also reporting an intermediate or complex repair for a larger lesion
• If lesion removal, incision, or repair requires debridement of non-viable tissue
  surrounding a lesion, incision, or injury to complete the procedure, the debridement is not
  separately reportable.
• Reflectance confocal microscopy (CPT codes 96931-96936) is performed to
  determine whether a skin lesion is malignant. The PTP edits allow providers/suppliers to report
  on the same date of service excision of the lesion if malignant, but not biopsy or excision of the
  lesion if benign.
• Closure/repair of a surgical incision is included in the global surgical package
  except as noted below. Wound repair CPT codes 12001-13153 shall not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090, or MMM. Simple, intermediate, and complex wound repair codes may be reported with Mohs surgery (CPT codes 17311-17315). Intermediate and complex repair codes may be
  reported with excision of benign lesions (CPT codes 11401-11406, 11421-11426, 11441-11471)
  and excision of malignant lesions (CPT codes 11600-11646). Wound repair codes (CPT codes
  12001-13153) shall not be reported with excisions of benign lesions with an excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440)

Control of bleeding during an operative procedure is an integral component of a
surgical procedure and is not separately reportable. Postoperative control of bleeding not
requiring return to the operating room is included in the global surgical package and is not
separately reportable. However, control of bleeding requiring return to the operating room in the postoperative period is separately reportable using modifier 78.