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
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