Cassandra Posted Thu 20th of May, 2010 13:59:41 PM
Can someone please tell me exactly how to determine the size of a lesion. Thanks
SuperCoder Answered Thu 20th of May, 2010 14:35:29 PM
Documentation of lesion excision size is absolutely essential for code reporting purposes. Inadequate documentation of such can potentially mean the difference between several levels of codes and may result in an inappropriately low reimbursement. Even when documentation of lesion excision size exists, it is necessary that the appropriate measurements are selected for use in the calculation. CPT describes the total excised lesion size as the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter). For instance, if an OMS removes a benign lesion from the skin of a patient's face measuring 2.0 cm at its widest point with margins of 0.3 cm removed on each side, the total excised diameter would be 2.6 cm (2.0 cm + 0.3 cm + 0.3 cm = 2.6 cm) reportable with CPT code 11443 (excision, other benign lesion including margins, except skin tag, face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm) with an associated non-facility relative value (RVU) of 5.43. Had the diameter of the excised margins not been documented, or ignored in the calculation, code 11440 (excision, other benign lesion including margins, except skin tag, face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) with a much lower nonfacility RVU of 3.25 would have been inappropriately reported. For further explanation and helpful diagrams, refer to the guidelines immediately preceding the "Excision - Benign Lesions" codes beginning with 11400 in the Surgery section of the current AMA CPT Professional Edition Coding Manual. Also note benign lesion excision codes in the 11400 - 11446 range and malignant lesion excision codes in the 11600 - 11646 range include simple closure. When repairing excised lesion areas requiring more than simple closure, (i.e., intermediate or complex closure as defined in CPT's Surgery/Integumentary System chapter immediately preceding code 12001) a second code should also be reported. Codes 12031 - 12057
Patricia Answered Tue 29th of June, 2010 16:54:14 PM
I need a little guidance when coding an excision of lesion with intermediate repair codes. There are 2 lesions in two different parts of the body and both are closed with intermediate repair. I now when there are multi lesions in the same area, the length of ea one is totaled together the proper code is selected. But in this case, should 12032 be coded twice; one for each area? Appreciate any help
SuperCoder Answered Wed 30th of June, 2010 06:30:43 AM
Code 12032 reports wound repair of specific anatomical areas. It says: "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm." This means repair of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet)are taken as repair of one anatomical area and the total length of multiple wounds of these areas should be taken as the acutal length of wound. If the second wound is within this area then you need to add the lengths of both the wounds to get your wound size. Otherwise you need to take a second code for the wound that does not belong to this anatomical area. I hope this helps. Going thro the CPT guideline in your CPT book/software will also make things clear for you.
Patricia Answered Wed 30th of June, 2010 12:20:27 PM
Thanks ash sometimes the guideline is confusing and you sometimes interpret info differently from what is intended.