Repairs with Lesion Excision Arent an Open-and-Shut Case

Physicians and coders should remember that in most cases, lesion excision will include closure, depending on the level of repair required.
Excision codes 11400-11446 (benign) and 11600-11646 (malignant) describe full-thickness (that is, through-the-dermis) lesion removal with margins and include simple (nonlayered) closures (CPT 12001-12018). As noted in CPT, however, "The closure of defects created by incision, excision or trauma may require intermediate or complex closure. Repair by intermediate or complex closure should be reported separately."

But even this is not a hard-and-fast rule at least for Medicare and other payers who follow the national Correct Coding Initiative (CCI). For these payers, intermediate (12031-12057) or complex (13100-13152) repairs are bundled by CCI to excisions of benign lesions of 0.5 cm or less (11400, 11420 and 11440), presumably because even complex repair of such a small wound does not increase physician effort considerably (see chart).

For example, the surgeon removes four lesions (0.5 cm, benign with complex repair; 0.5 cm, malignant with complex repair; 1.5 cm, benign with simple repair; and 2.0 cm, benign with complex repair) from the patient's right leg. The payer is Medicare.
In this case, you cannot claim separate closure for the first lesion because it is 0.5 cm or less (and therefore bundled by CCI). You may claim separate closure for the second excision, even though it is 0.5 cm or less, because it is malignant rather than benign. Do not report a separate repair code for the third excision, because simple repair is always bundled. You may report complex repair separately with the final excision because the benign lesion measured greater than 0.5 cm.