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Emergency Department Coding & Reimbursement Alert

READER QUESTIONS :Does a Single Cut Lead to Excision Exception?

- Published on Thu, Jul 02, 2009

Question: Our nonphysician practitioner (NPP) discovers a pair of benign lesions on a patient's right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with a single excision. Should I report one or two excision codes?

Indiana Subscriber

Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Add the lengths of the two excisions to the margin between the lesions, and choose a code based on that length. (In your scenario, 0.5 + 0.3 + 1.0 = 1.8 cm.). On the claim, report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm) for the excision.

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