Coding Lesions and Soft Tissue Excisions

April 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Categories:   Coding   Dermatology|Plastic Surgery  
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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).

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