Coding for lesion removals can annoy a Coder as much as it does the Physician.
Coders should keep in mind the following when reviewing the documentation for coding of lesion removal:

- Was the lesion shaved, excised or destroyed?
- Was it a wart or malignant lesion or benign lesion that was removed?
- Lesions can include moles, cysts, or skin tags.
- For the coding of skin tags the codes to be used are 11200 or 11201.
- Should review the length and width of the lesion removed along with its margins.
- Look for additional procedures done by the Physician such as debridement or repair post removal of lesion.
- Generally, simple repair is inclusive of the removal and cannot be coded separately.
- Review the documentation for multiple scenario or distinct scenario if more than one lesion excised.

Coders should know there are four methods of lesion removal and which category the service falls into before coding the documentation:

1. Biopsy (11100-11101): Removes part of a lesion for confirming the diagnosis. The pathology report along with the documentation is required to code this service.
2. Shaving (11300-11313): Removes the entire lesion but does not penetrate the underlying fat. Moles are the most common lesion that falls into this category.
3. Excision, benign (11400-11471) or malignant (11600-11646): Removes the entire lesion along with the underlying fat. Generally requires layered closure, which is separately codeable.
4. Destruction, benign or premalignant (17000-17250) or malignant (17260-17286): Destroys lesions by laser or "cryo," technique as done with warts.

Documentation Requirements:
- The physician should document the type of removal accurately.
- Sometimes physicians confuse medical terms with CPT language. They say "shave biopsy" or "biopsy excision" when documenting their service. For coding purposes, however, the coder should consider the procedure method as either a biopsy or an excision or a shaveshould not mix terms.
- The documentation must include the size of the lesion and whether it was sent for biopsy.

Reimbursement Viewpoint:
Of the four lesion-removal methods:
- An excision is typically reimbursed the highest
- Second highest reimbursement is typically a shave
- Third is typically biopsy
- Fourth is typically destruction
- Reimbursement is usually at least 30 percent higher for malignant lesion removal than for benign.

Correct Coding initiatives required are:
- Correct coding depends on the lesion's size and location. Many physicians guess the size, which is fine if the guess is well documented in the record.
- Even 1 centimeter less or more can make a huge difference in reimbursement.
- If a lesion is re-excised, the acceptable standard to calculate size is the width multiplied by 2.5.
- Also, the physician should document the compatible ICD-9 code that would not make it inclusive with the previous encounter but show it as a distinct one from the previous, hence getting it reimbursed for the physician.
- Medicare rules state that anything smaller than .5 cm of repair may not be coded.

Limitations related to lesion removal:

1. First, don't use lesion-removal codes when removing skin tags, which have their own codes (11200-11201).
2. Medicare guidelines say that a lesion removal must be both medically necessary and symptomatic in order to be reimbursable. For example, a patient wants a mole removed from her face, which has been there for years and has never changed color. The removal becomes more cosmetic in nature as opposed to being medically necessary, which is not covered by insurances.

However, if the mole has changed its color and kept bleeding from clothing irritation etc, Medicare would consider its removal medically necessary and reimburse for the same.

Modifier usage related to Lesion removal:
- Coder would need to append modifiers when the physician removes multiple lesions: -51 (multiple procedures) if there were multiple lesions at the same site;
- Modifier 59 (distinct procedural service, different anatomical site) if, for example the physician removed lesions from the back and the arm;
- Modifier 76 (repeat procedure by the same physician) if the physician needed to re-excise a lesion within the global period of 10 days.
- Modifier 79 (Unrelated during post op period) when the physician removes the lesion within the global period for a different medical necessity ICD or any complication of the previous.

Author: Ramya Vincent