Benign Versus Malignant
Benign lesion excisions are coded with 11400 to 11471 and malignant lesions with 11600 to 11646, each grouped by anatomic site and size. Because the code depends on the diagnosis, many practices hold excision claims until the pathology report confirms whether the lesion is malignant.
Measuring The Excised Diameter
The size used for coding is the greatest clinical diameter of the lesion plus the narrowest margins required for complete excision, measured before excision. The note should record both the lesion size and the margins. Measuring the specimen after it is removed understates the size.
Biopsies And Shaves
Biopsies are reported by technique: 11102 and 11103 for tangential biopsy, 11104 and 11105 for punch biopsy, and 11106 and 11107 for incisional biopsy. Shave removals of elevated lesions use 11300 to 11313. The method documented in the note determines the code.
Repairs
Simple closure is included in the excision codes. Intermediate (layered) and complex repairs are reported separately, by repair length and site, when documented. Adjacent tissue transfer includes the excision and is not reported with it on the same lesion.
The Pathology Claim
The dermatopathologist or pathology lab bills the surgical pathology code (most often 88305) for each specimen examined. If the practice reads its own slides, the professional and technical components must be billed correctly for the arrangement in place.
Frequently Asked Questions
- What if the pathology comes back malignant after a benign code was billed?
- The claim should be corrected to the malignant excision code. Holding excision claims until pathology is final avoids corrected claims.
- Can a biopsy and an excision of the same lesion be billed on the same day?
- Generally no. When the excision is performed at the same session, the biopsy of that lesion is included.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.