Full Answer
Subsequent to excision, the pathology report identifies the lesion as malignant. The correct code is 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4 cm.
Only those lesions specifically identified as malignant may be assigned a code for malignancy. Exception: If a surgeon performs a re-excision to obtain clear margins at a later operative session, you may report the same malignant diagnosis that you linked to the initial excision because the reason for the re-excision is malignancy.
This procedure is also called curettement. Lesion destruction occurs via laser surgery, electrosurgery, or other methods (but not a scalpel). Always expect a diagnosis of 702.0 Actinic keratosis with the premalignant lesion destruction codes (17000-17004).
The excision of a malignant skin lesion including margins will be considered medically necessary when a pathology report verifies the existence of a malignancy.
The correct code is 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4 cm.
Codes 11420- 11426 are used for the excision of benign lesions of the scalp, neck, hands, feet, and genitalia, whereas codes 11440-11446 are used for excision of benign lesions of the face, ears, eyelids, nose, lips, and mucous membrane.
CPT codes 11400-11446 should be used when the excision is a full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure.
This type of excision would be most appropriately reported using the excision of malignant lesion including margins codes 11600- 11646.
CPT® 40810 in section: Excision of lesion of mucosa and submucosa, vestibule of mouth.
CPT® Code 11402 in section: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs.
ICD-10-CM Code for Disorder of the skin and subcutaneous tissue, unspecified L98. 9.
CPT® Code 11606 in section: Excision, malignant lesion including margins, trunk, arms, or legs.
A primary excision should be billed based on the largest diameter of the lesion plus the narrowest lateral margins. For example, a round 4 mm lesion placed centrally in an 8 mm punch has a lesion diameter of 4 mm and 2 mm margins all around.
2022 ICD-10-PCS Procedure Code 0CB1XZX: Excision of Lower Lip, External Approach, Diagnostic.
If the ob-gyn destroys two small lesions, you would usually report 56501. But if he destroys two invasive lesions, the physician might consider this extensive and use 56515. Generally, however, destroying more than three lesions places you in the extensive range, and you would submit 56515.
CPT® Code 11622 in section: Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33818 Excision of Malignant Skin Lesions provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials.
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Excision of Malignant Skin Lesions. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy.
A skin lesion is any alteration in the normal skin architecture. Lesions can be benign, pre-malignant or malignant. The most common malignant lesions are Basal Cell Carcinomas (BCC), Squamous Cell Carcinomas (SCC) and Melanomas.