Pilonidal Disease Excision

Question:

I frequently perform adjacent tissue transfers (CPT 14000, 14001, 14020). When I excise pilonidal disease (CPT 11770, 11771, 11772) and then perform an adjacent tissue transfer, can I report both the excision and the tissue transfer codes, or is only the tissue transfer separately billable?

Additionally, in cases where I excise a malignant lesion (CPT 11604, 11606) and close the defect with an adjacent tissue transfer, my understanding is that only the adjacent tissue transfer code (e.g., 14000) is reportable, and the excision is considered included. Is this correct?

Answer:

This is a great question. Even though pilonidal excision is a “disease excision” rather than a lesion excision, CPT still treats the excision as included in the ATT. If you excise pilonidal disease and close with an adjacent tissue transfer (e.g., Limberg flap, Karydakis flap, Z-plasty), you bill only the ATT code (14000–14001–14020 etc.). Keep in mind when you perform an adjacent tissue transfer to close a defect, you do NOT separately bill the excision of a lesion (benign or malignant).

The ATT includes:

• Creating the defect (whether by trauma or excision)

• Preparing the wound bed

• Closing the defect with the flap

The excision is considered included in the ATT code.

This applies to:

• Benign lesion excision (11400 series)

• Malignant lesion excision (11600 series)

• Benign cyst excision (e.g., pilonidal disease 11770–11772)

• Scar revision excision

• Any excision that results in the defect you are closing with ATT

*This response is based on the best information available as of 07/16/26.

Biopsy of Lip

Question:

A provider performed a shave biopsy of the vermillion border using a dermablade. Would you report 11102 or 40490 for cases like this? What warrants reporting CPT Code 40490?

Answer:

Thank you for your question. For a shave biopsy of the lip skin or vermillion border performed with a dermablade, 11102 is the correct code. CPT 11102 covers tangential (shave/scoop/curette) biopsies of skin and skin appendages, which includes the cutaneous lip and vermillion. A dermablade is the classic instrument for a tangential/shave technique, which maps directly to the 11102 description. The lip, for integumentary coding purposes, is treated as a skin site when the biopsy involves the surface epithelium/vermillion using a shave technique

In order to report CPT code 40490 (biopsy of lip), the biopsy requires incisional technique into the deeper lip tissue (submucosa, muscle). The lesion is on the mucosal surface of the lip (wet mucosa, not vermillion or skin). A punch or excisional approach is used on the lip mucosa and the clinical intent is to sample submucosal pathology (e.g., suspected mucocele, minor salivary gland lesion, deeper fibrosis).

*This response is based on the best information available as of 06/04/26.

Skin Tag Removal

Question:

Is it correct to report 11300-11313 for the removal of 4 skin tags by shave?

Answer:

In this scenario, the diagnosis determines the correct code selection. For skin tags, the appropriate codes are 11200–11201. The guidelines for these codes state, “Removal by scissoring or any sharp method,” which would include “shave.” Therefore, it would not be appropriate to report codes 11300–11313 (shaving of epidermal or dermal lesions) for this service. The removal of 4 skin tags would be correctly reported with 11200.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 05/07/26.

Medical Decision Making

Question:

The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making?

Answer:

Based on the condition alone, a recurrent keloid that is stable and only mildly symptomatic would generally meet Low MDM under the “Number and Complexity of Problems Addressed” element. However, the final MDM level cannot be determined without considering the other two MDM elements: data reviewed and the risk of treatment and management. If no data is reviewed and management is limited to observation, conservative measures, or a minor procedure with no risks, the overall MDM would remain low.

*This response is based on the best information available as of 04/02/26.

Epidermoid Cyst

Question:

My physician removed an epidermoid cyst and I am not certain how to code this. What CPT code is used for the removal of a 1.2 cm epidermoid cyst on the scalp that is removed through a small linear incision, is dissected and removed in total. I think I should use the I&D code 10060 but I am not sure. Can you help?

Answer:

Thank you for your question. Because the cyst was removed through a small linear incision, dissected free and removed in total (en bloc) from the scalp, this meets the definition of a benign lesion excision not an incision and drainage (I&D). The correct CPT code based on the 1.2cm size and anatomic location is 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).

*This response is based on the best information available as of 03/05/26.

Coding a Flap after Mohs Surgery

Question:

A patient was seen by a dermatologist in their clinic for a MOHS procedure. After completion of MOHS, the patient went to the ambulatory surgical center for our ENT provider to perform CPT 14060. Since the ENT did not perform the MOHS excision but did perform the flap, would a 52 modifier have been appropriate since the opening excision was performed by a different specialty at a different location?

Answer:

Thank you for your question. Modifier 52 (Reduced Services) is only used when the same provider performs a service but reduces or does not complete the full work of the CPT code.

In this case your ENT did perform the full flap procedure described by CPT 14060. The fact that a different specialty performed the Mohs excision beforehand does not mean your ENT performed a reduced service. The ENT was not expected to perform the excision because the Mohs surgeon already did it. The flap reconstruction can be billed by ENT without a modifier.

*This response is based on the best information available as of 02/05/26.