Coding Lesions and Soft Tissue Excisions

April 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS

Categories: Coding Dermatology|Plastic Surgery

There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions.

The code selection will be determined upon the following:

Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain)
Technique
Topography (anatomic location)
The size
Tissue Level
Type of closure required

Layers and thickness of the skin

1-Epidermis - Split-thickness between the epidermis and dermis
2-Dermis - Full-thickness of the epidermis and the entire dermis
3-Subcutaneous - Below the dermis, meaning fat and connective tissues

Global Days

If, for some reason, a re-excision is required, keep an eye on the global days for the procedure that was done. For example, the shaving of an epidermal or dermal lesion is considered an "endoscopic minor procedure" and has 000 global days. An excision, however, is considered a minor procedure and carries a 10-day global period. A 10-day global means the 10 days start the day of the procedure, and any postoperative procedures are included in the procedure and generally are not payable for 10 days.

Coding Lesions of the Integumentary System

To determine code selection, measure the lesion and the surrounding tissue or most narrow margin of normal tissue required for complete excision.
Each lesion is reported separately.
If adjacent tissue transfer is required, only report the tissue transfer 14000-14302. The excision of the lesion is not reported.
According to AMA, excision is defined as full-thickness.

Shaving of Epidermal or Dermal Lesions Procedures 11300‑11313

11300 -11303 trunk, arms, or legs
11305 -11308 scalp, neck, hands, feet, genitalia
11310 -11313 face, ears, eyelids, nose, lips, mucous membrane

Removal of epidermal and dermal lesions without a full-thickness dermal excision
Does not require suture closure
Includes Local anesthesia

Excision-Benign Lesions Procedures on the Skin 11400-11446

11400 -11406 trunk, arms or legs
11420 -11426 scalp, neck, hands, feet, genitalia
11440 -11446 face, ears, eyelids, nose, lips, mucous membrane

Includes simple closure (non-layered). However, if intermediate (12031-12057), complex (13100-13153), or reconstructive closure (15002-15261, 15570-15770) is required, report the appropriate codes separately
Includes local anesthesia

Excision-Malignant Lesions Procedures on the Skin 11600 ‑11646

11600 -11606 trunk, arms or legs
11620 -11626 scalp, neck, hands, feet, genitalia
11640 -11646 face, ears, eyelids, nose, lips, mucous membrane

Includes simple closure (non-layered). However, if intermediate (12031-12057), complex (13100-13153), or reconstructive closure (15002-15261, 15570-15770) is required, report the appropriate codes separately
If pathology shows the excision margins were not adequate, and additional excision is done during the post-op period, append modifier 58 to the re-excision procedure
Includes local anesthesia

Destruction Procedures on Benign or Premalignant Lesions 17000-17250

17000-17003 premalignant lesions (e.g., actinic keratoses)
17004 premalignant 15/>
17106-17108 cutaneous vascular proliferative lesions (e.g., laser technique)
17250 Chemical

Generally does not require closing
Destruction means ablation by any method, including electrosurgery, cryosurgery, laser, and chemical treatment
Includes local anesthesia

Specific anatomic sites will be found through the CPT manual as well for coding other types of lesions. Notice a prompt on certain chapters and sections where you may see a note (Unless listed elsewhere) stating there may be a code with a more specific anatomic location.

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs

If there is a more specific code, always use the description that best describes the procedure or is the most specific such as the codes listed below:

vestibule of mouth	40820	anus	46900-46917, 46924
penis	54050-54057, 54065	vulva	56501, 56515
vaginal	57061, 57065	eyelid	67850
conjunctiva	68135

Mohs 17311-17315

Mohs micrographic surgery includes two separate and distinct capacities; surgeon and pathologist. If one of these responsibilities is not done these codes should not be reported.

17311 ‑17312 head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels

17313 ‑ 17314 (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs
Trunk/Arm/Leg each additional block any stage

Skin Tags

Removal of Skin tags is coded using 11200 and 11201. CPT 11200 reports up to and including 15 lesions, 11201 is the add-on code used to report each additional 10 lesions, 11201 is listed in addition to the primary procedure 11200.

Soft Tissue Excision using site-specific codes

Spread through the CPT manual. You will notice site-specific codes used for Soft Tissue Excision Codes such as benign tumors or lipomas confined to the subcutaneous tissue below the skin but above the deep fascia.

Code selection is based on the tumor's size and location and by measuring the tumor's greatest diameter plus the margin required for complete excision of the tumor. In general, there are two codes for each area, one for smaller excisions and one for larger excisions.

abdominal wall	22902, 22903	leg or ankle	27618, 27632
back or flank	21930, 21931	external auditory canal	61645
upper arm or elbow	24075, 24071	face or scalp	21011, 21012
hand or finger	26115, 26111	foot or toe	28043, 28039
forearm or wrist	25075, 25071	hip or pelvis	27047, 27043
thigh or knee	27327, 27337	neck or anterior thorax	21555, 21552
shoulder	23075, 23071

Coding

Lesions are billed as separate units of service if samples are taken from different lesions and separate sites.

If a large lesion is sampled at several separate locations or sites using a single biopsy code, only one code is reported.

Use 11400-11646 for complete lesion excision; don't forget to include margins when using these codes, for example, 11400 (excised diameter 0.5 cm or less), 11401 (excised diameter 0.6 to 1.0 cm).

Repair by intermediate or complex closure is reported separately.

Append modifier 58 to re-excision procedures done during the post-op period.

Append Modifier 59 for excision in the same general location but distinct or independent for the second and subsequent codes.

Append Modifier 51 for Multiple procedures (some payers such as Medicare may not require Modifier 51).

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