Want to Max Out Lesion Coding Returns? Measure Specimens Pre-Path

Posted on 15 Jan, 2016 |comments_icon 2|By Chris Boucher

Remember: Include healthy tissue provider excises in final tally.

When faced with a lesion excision claim, you’ll need to follow a couple of specific guidelines to carve out all your deserved reimbursement.

The basics: Obtain the proper excision measurements — and properly ID the pathology of the lesion — and you’ll be on your way to a proper claim for these procedures.

Get ahead of the game with a couple of tips on these vital components in your lesion coding machine.

Measure Margins, Wound Area

When a provider performs lesion removal, he will remove the lesions as well as margins of healthy tissue around the wound. For your lesion removal claims, you need to add the dimensions of the lesion your provider removes to the margins, and then use that length to determine code choice.

Example: The physician removes a 0.9 cm benign lesion from a patient’s left leg with a 0.4 cm margin. This means that total excision size was 1.3 cm. On the claim, you would report 11402 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 1.1 to 2.0 cm) for the removal.

See also: When Clock Strikes Midnight, Switch Up Observation Coding

Also, be sure to measure the lesion size before sending the specimen to pathology. Otherwise, the specimen will shrink, and you’ll have to downsize your excision area.

Get Path Report Before Filing

If at all possible, you should wait on the pathology report before coding a lesion as benign or malignant. You could end up miscoding, obviously — but the consequences could be much worse for the patient who the physician misdiagnoses.

Example: You code for a malignant lesion removal without confirmation from the pathology report, and the specimen comes back benign. The patient now has a documented cancer diagnosis, which is not easy to erase from his medical record.

Best bet: Practice patience to protect your patients and your practice. Wait on the pathology report before choosing a lesion excision code. If, for some reason, you must file the claim without pathology, always defer to the benign lesion codes.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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