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 1130011313

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 (15002-1526115570-15770) is required, report the appropriate codes separately
  • Includes local anesthesia 

Excision-Malignant Lesions Procedures on the Skin 1160011646

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 (15002-1526115570-15770) 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.  

1731117312 head, neck, hands, feet, genitalia, or any location with surgery directly involving   muscle, cartilage, bone, tendon, major nerves, or vessels

1731317314 (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).

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association