Wedge Excision with Reconstruction

Question:

My physician did a full thickness wedge excision with an Estlander flap of the right upper lip with reconstruction utilizing a cheek flap, adjacent tissue transfer. The defect measures 27 sq. cm. The physician used a mucosal graft from the wedge excised from the lip with reconstruction of the vermillion of the right upper lip. I am not sure what CPT code I should use?

Answer:

You should use CPT code 40525 when the physician removes a full thickness portion of the lip with local flap reconstruction. A “V” incision may be made around the lesion and through the full thickness of the lip. The lesion and surrounding tissues are removed. A local skin flap is incised and advanced to the site of the surgical wound and sutured into place with layered closure.

*This response is based on the best information available as of 12/17/20.

Paring or Cutting

Question:

I am new to Dermatology coding and need some help. The previous coder told me for CPT 11055 (paring or cutting) that if more than one is removed we bill the codes 11055 and 11056?  My physician removed 4 calluses by cutting and I billed CPT 11055 and 11056. The claim was denied by the carrier as bundled.  How should I have billed this?

Answer:

When the physician removes a benign hyperkeratotic skin lesion such as a corn or callus by either cutting, clipping or paring you report only one code depending on number of lesions removed.  For one lesion you report 11055, for 2-4 lesions you report 11056 and more than four is reported with 11057.  You cannot report any of these codes together as they are bundled under NCCI and you cannot use Modifier 59 to bypass the edit as it not allowed.

*This response is based on the best information available as of 12/03/20.

Actinic Keratoses

Question:

When using liquid nitrogen to for irritated actinic keratoses what CPT codes should I use? I have been using 17110 and my coder told me that was wrong.

Answer:

You should report 17000 for the first AK (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion) and 17003 foreachlesion treated from 2-14. If you remove 15 or more lesions report 17004 (15 or more lesions). Make certain you document the location of each lesion, method of removal and numbers treated.

*This response is based on the best information available as of 9/3/20.

Soft Tissue Tumor Removal

Question:

My physician removed a soft tissue tumor on the patient’s foot measuring 1.2 cm. Documentation indicates subcutaneous. He is coding this as a benign excision and wants to report CPT code 11422. Can you tell me if this is correct?

Answer:

The correct CPT code to report is CPT code 28043 (Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm). You would not report a soft tissue tumor excision with the benign skin lesion excision codes.

*This response is based on the best information available as of 7/9/20.

Keloid Scar Destruction

Question:

What CPT code should you report for laser removal of a keloid scar? What should be documented in the procedure note?

Answer:

You would report 17110. Documentation should always include:

Indications for proceduresRisks/BenefitsDocument location of lesion/keloid destroyedCM size of lesion before removal/destructionMethod of destructionDetail of the procedureAnesthesia/medications

*This response is based on the best information available as of 1/23/20.

Measurements for Excision of Lesion Removal

Question:

Our coder sometimes uses measurements listed in the pathology report for lesion excisions, because the measurements are unclear or missing in the procedure note. Is this ok?

Answer:

No, for several reasons. Once removed, tissue(s) shrink so don’t depend on the measurements listed in the pathology report as it will most likely be smaller than the actual excision. And It is always necessary to have the measurements of the excision documented in the procedure note. So, if you have Question:s or need documentation clarification, ask your provider for help so he/she can amend the note prior to billing if necessary.

Excision means lesion plus margins (the narrowest margin), not just lesion itself. CPT 2019 gives us several illustrations on page 83 of how to calculate for these codes, so make sure to share this information with your coder and provider.

*This response is based on the best information available as of 12/19/19.