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The table below lists the many lesion and tumor excision coding options that exist with the 2010 CPT code changes. Although Medicare payment varies for the various skin and soft tissue lesion excision codes, you should focus on documenting, coding and billing these cases appropriately regardless of the payor and reimbursement. While the CPT 2010 code book contains many new codes and guidelines for the excision of lesions located beneath the dermis of the skin, the coding of skin lesions hasn't changed. Per the note above code 11400 in the code book, integumentary system codes 11400 to 11646 are still used for the "full-thickness (through the dermis) removal of a lesion."
The CPT 2010 code book gives us a more structured, organized approach to code the excising of lesions located in the subcutaneous tissue, fascial, subfascial and deeper soft tissues. These codes are for excising shoulder soft tissue lesions:
- 23071. Excision, tumor, soft tissue of shoulder area, subcutaneous; 3cm or greater
- 23073. Excision, tumor, soft tissue of shoulder area, subfascial (intramuscular); 5cm or greater
- 23075. Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3cm
- 23076. Excision, tumor, soft tissue of shoulder area, subfascial (intramuscular); less than 5cm
- 23077. Radical resection of tumor (malignant neoplasm), soft tissue of shoulder area; less than 5cm
- 23078. Radical resection of tumor (malignant neoplasm), soft tissue of shoulder area; 5cm or greater.
Before the CPT 2010 code book, noting the size of lesions was only required for the excision of skin lesions. But now that the revised and new soft tissue lesion excision codes include the size of the tumor, physicians will need to document the size of both skin and soft tissue lesions.
Documentation tips to follow Document this clinical information in the medical record when you excise a skin or soft tissue lesion:
- the morphology of each lesion (benign, premalignant or malignant);
- the dimensions of each lesion plus the margins required for complete excision of each lesion;
- the anatomical site of each lesion;
- the surgical technique used to remove each lesion (excision, shaving, destruction [indicate the method of destruction] or Mohs' micrographic surgery [chemosurgery]); and
- the surgical technique used to close each lesion defect site (adhesive strip application, chemical or electrocauterization, simple repair, layer closure, complex repair, adjacent tissue transfer/rearrangement, skin graft application or skin substitute application).
Coding tips to keep in mind
- Code separately the intermediate or complex repair of a skin lesion excision defect site.
- Code separately the complex repair or reconstruction of a soft tissue lesion excision defect site.
- Intermediate closure is used in instances when 1 or more layers of deep sutures are required to approximate dermis and/or obliterate space remaining within the subcutaneous tissue, in addition to a separate outer layer for fine epidermal/dermal approximation. Code wounds that require closure of subcutaneous tissue or more than 1 layer of tissue beneath the dermis as intermediate repair, unless the criteria for a complex closure are met.
- Complex closure includes the following techniques: dog ears/Burrow's triangles repair; the layered repair of lacerations that also require debridement of wound edges before closure; extensive undermining to release and redistribute tension vectors to allow proper closure and to avoid uncertain distortion such as of the eyelid or lip.
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CPT Coding Resource: Lesion and Tumor Surgical Excision | ||||
Anatomic Site |
Skin Lesion |
Subcutaneous Soft Tissue Tumors |
Subfascial Soft Tissue Tumors |
Radical Soft Tissue Tumors |
Abdominal Wall | 11400 to 11406, 11600 to 11606 | 22902, 22903 | 22900, 22901 | 22904, 22905 |
Ankle or Leg | 11400 to 11406, 11600 to 11606 | 27618, 27632 | 27619, 27634 | 27615, 27616 |
Back or Flank | 11400 to 11406, 11600 to 11606 | 21930, 21931 | 21932, 21933 | 21935, 21936 |
Ears | 11440 to 11446, 11640 to 11646 | 69145 | 69145 | 69150, 69155 |
Elbow or Upper Arm | 11400 to 11406, 11600 to 11606 | 24071, 24075 | 24073, 24076 | 24077, 24079 |
Eyelids | 11440 to 11446, 11640 to 11646 | 67840 | 67961, 67966 | 67961, 67966 |
Face or Scalp | FACE: | 21011, 21012 | 21013, 21014 | 21015, 21016 |
Fingers or Hand | 11420 to 11426, 11620 to 11626 | 26111, 26115 | 26113, 26116 | 26117, 26118 |
Foot or Toes | 11420 to 11426, 11620 to 11626 | 28043, 28039 | 28045, 28041 | 28046, 28047 |
Forearm or Wrist | 11400 to 11406, 11600 to 11606 | 25071, 25075 | 25073, 25076 | 25077, 25078 |
Genitalia | 11420 to 11426, 11620 to 11626 | MALE: | FEMALE: | FEMALE: |
Hip or Pelvis | 11400 to 11406, 11600 to 11606 | 27043, 27047 | 27045, 27048 | 27049, 27059 |
Knee or Thigh | 11400 to 11406, 11600 to 11606 | 27327, 27337 | 27328, 27339 | 27329, 27364 |
Lips | 11440 to 11446, 11640 to 11646 | 40500 to 40530 | 40500 to 40530 | 40500 to 40530 |
Neck or Anterior Thorax | NECK: | 21552, 21555 | 21554, 21556 | 21557, 21558 |
Shoulder | 11400 to 11406, 11600 to 11606 | 23071, 23075 | 23073, 23076 | 23077, 23078 |
• SKIN LESION. In the CPT 2010 code book, there are paragraphical notes above code 11400 and code 11600 that state that these codes [11400 — 11646] classify the "Excision (including simple closure) of benign/malignant lesions of skin. Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed ... Repair by intermediate or complex closure should be reported separately."
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How Would You Code This Case? |
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Pre-operative Diagnosis: Malignant melanoma, left forearm.
CPT Codes:
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