Unlike other treatment codes, dermatology coding seems difficult for coders because these codes are badly loaded with many difficult aspects like coders have to memorize a lot of terms and unique aspects such as sizing wounds and lesions. Coders who generally work in a specialty that only occasionally uses concepts from this section, such as urology, gynecology, and family practice, may have more difficulty with this section of CPT.
Before we go in excision CPT code’s detail, it’s important to have a basic idea of excision itself. An excision, whether for benign or malignant lesions, is basically full-thickness (through the dermis) removal of a lesion, including margins and includes simple closure when performed. Simple closure means non layered. Coding with the most accurate and appropriate procedure codes can expedite reimbursement. If the payer denies reimbursement, then your documentation will support everything you coded and billed. So a coder must insist to have a very detailed information of procedure that has been done.
Its more than obvious that as a coder you always have to remember the modifiers to accurately unbundle the separately identifiable lesions. Carefully review modifiers -51 (multiple procedures),- 59 (distinct procedural service), -RT (right side), and –LT (left side) to ensure that your coding is complete.
Dermatology Excision CPT Codes
To do the above mentioned procedure, there are also some other techniques. The difference between excision and other techniques lies in the removal of the entire thickness of the dermis through to the subcutaneous tissue, which is done in excision. Each excised lesion is reported separately. The code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision. The measurement of lesion plus margins is usually done prior to excision. These services are appropriately reported using CPT codes 1140x Excision – benign lesions or 1160x Excision – malignant lesions.
Coders must be familiar with benign and malignant masses along with actions such as shaving, destruction, and performing biopsies. In addition to these, they must identify simple, intermediate, and complex repairs, and deal with sizing terms such as length, depth, width, and circumference. To know the difference between centimeters (cm) and millimeters (mm) is also important.
Dermatologists need to provide their coders detailed information, only than they can code correctly, but this may not be the case for all other providers. Coders who need to code dermatology-related procedures need to understand what each skin condition really is.
Situation can be more difficult for coders if the physician or provider does not provide a clear description of the procedure he or she performed. The physician may state that he or she is going to biopsy a lesion, when he or she really performs a shave. Being a coder, if you are not very clear regarding the documentation then it’s better to ask the physician for further clarification. In the light of that clarification, you may better able to amend the note. Once that is completed, then code it and bill your claim to the insurance carrier.
The documentation of procedure is critical to ensure accurate reimbursement for the procedures performed. The relative value units (RVU) for code 11100 may be different than the RVU attached to code 11300. You can imagine the complexity of this process by looking at the procedures that come under both codes. Code 11100 is used for biopsy of skin, subcutaneous tissue and/or mucous membrane and single lesion while code 11300 is used for shaving of epidermal or dermal lesion, single lesion; diameter .5 cm or less.
CPT Codes For Dermatology
Here are some important Dermatology codes with description
11100 Biopsy skin 1 lesion
40490 Biopsy lip
41100 Biopsy tongue anterior
41108 Biopsy floor of mouth
54100 Biopsy penis
67810 Biopsy eyelid
69100 Biopsy external ear
15789 Chemical peel, facial; dermal
15783 Dermabrasion; superficial, any site, (eg, tattoo removal)
11719 Trimming of nondystrophic nails, any number
12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and /or extremities (including hands and feet); 2.5 cm or less
12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and /or extremities (including hands and feet); 2.6 cm to 7.5 cm
2020 Treatment of superficial wound dehiscence; simple closure
12021 Treatment of superficial wound dehiscence; with packing
11600 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less