21011 Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm 21012 2 cm or greater 21013 Excision, tumor, soft tissue of face or scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm 21014 2 cm or greater 21016 Radical resection of tumor, soft tissue of face or scalp, 2 cm or greater
Full Answer
The correct code is 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4 cm. Example 2: The physician removes three lesions from the right arm. Pathology determines that two of these (with excised diameters of 1 cm and 1.5 cm) are benign. The third lesion (excised diameter 2.5 cm) returns malignant.
An ambiguous, but moderate to high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion. This type of excision would be most appropriately reported using the excision of malignant lesion including margins codes 11600- 11646.
Prior to excision, the lesion measures 1.5 cm at its widest. To ensure removal of all malignancy, the surgeon allows a margin of at least 1.5 cm on all sides. In this case, you would add the size of the lesion (1.5 cm) and the double width of the narrowest margin (1.5 cm x 2 = 3 cm) for a total of 4.5 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.
11440-11446Codes 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.
This type of excision would be most appropriately reported using the excision of malignant lesion including margins codes 11600- 11646.
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. The provider should use the appropriate CPT code and the diagnosis code should match the CPT code.
CPT® Code 11406 in section: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs.
In plain language, the excised diameter equals the length of the lesion at its longest point, plus two times the narrowest margin. For example, if the lesion measures 1 cm at its greatest, and the surgeon removes a margin of 0.5 cm on all sides, the total excised diameter is 2.0 cm (1.0 cm + [2 x 0.5 cm]).
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 11420 in section: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia.
11443. EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM.
11310. Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less.
CPT® Code 11402 in section: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs.
12051-Intermediate repair, face, ears, eyelids, nose, lips, mucous membranes, 2.5cm or less. No modifiers needed.
CPT® Code 11442 in section: Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane.
To report a re-excision procedure performed to widen margins at a subsequent operative session, see codes 11600-11646, as appropriate. Append a modifier 58 if the re-excision procedure is performed during the postoperative period of the primary excision procedure."
The excision of a malignant skin lesion including margins (procedure codes 11600-11646) will be considered medically necessary when a pathology report verifies the existence of a malignancy.
When lesions are excised from multiple sites of the integumentary system, which of the following is the correct action the coder should take? Code all lesion excisions separately. The three (3) types of wound repair identified in CPT are: Simple, intermediate, and complex.
When coding for multiple excisions, you should append modifier 59 Distinct procedural service to the second and all subsequent codes describing lesion excision in the same anatomic location.
To select an appropriate code for excision of a benign (11400-11471) or malignant (11600-11646) skin lesion, you must determine the lesion’s diameter at its widest point, and add double the width of the narrowest margin (the portion of healthy tissue around the lesion also excised).
Example: A surgeon excises an irregularly shaped, malignant skin lesion from a patient’s right shoulder. Prior to excision, the lesion measures 1.5 cm at its widest. To ensure removal of all malignancy, the surgeon allows a margin of at least 1.5 cm on all sides.
This holds true even if the pathology report on the second excision returns benign because the reason for the re-excision was malignancy. Treat each skin lesion excision as a separate procedure, with an individual, dedicated diagnosis.