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To select an appropriate code for excision of a benign (11400-11471) or malignant (11600-11646) skin lesion, you must determine the lesion’s diameter at its widest point, and add double the width of the narrowest margin (the portion of healthy tissue around the lesion also excised). In the interest of both clinical and coding accuracy, providers should […]
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FINDINGS: -hemorrhoids (internal and external), Moderate in size
-polyp(s) – #1, 5 mm in size, Flat, the transverse colon, removed by hot biopsy and sent for pathology
Path report: Transverse colon polypectomy-Colonic mucosa with no significant histopathologic abnormalities.
I would think this polyp would not be coded if it’s only benign colonic mucosa, but it was removed, so if I code only Z12.11, would 45384 be covered? Would the polyp be coded as benign neoplasm D12.3? When I look under polyp/colon/transverse, that’s what it leads to.
Based on the CPT manual instructions that intermediate and complex closures should be reported separately, my physician wants to add a 59 modifier to the closure.
It is my understanding that Medicare considers simple, intermediate and complex closure inclusive when the removal of the benign lesion is .5cm or less.
The codes are NCCI edits and can be overridden by adding modifier 59 to the repair. Since the repair is not a separate encounter, separate structure, separate practitioner or unusual non-overlapping service, would modifier 59 really apply?
CPT’s 11440
CPT’s 12011, 12051, 13151
Please advise.
Thanks,
Camille Waterhouse, CPC
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain
When a dysplastic nevus with moderate atypia is removed via excision, wondering what would be most appropiate code if any from group III when no symptoms are present. Thoughts?
We have to code path results, if positive. How would this be coded – benign lymphoid pseudopolyp of the colon. Also, maybe because it’s so many years later – I can’t find a pseudopolyposis code in ICD-10 2018 (there is an old thread in these forums that says use pseudopolyposis)…there’s a K51.40 inflammatory polyps of the colon, but based on my diagnosis – it doesn’t sound inflammatory so I’m leery of using that. Is it a benign neoplasm of colon?
Thanks.
Kimberlee
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain
However, the secondary ICD 10 codes in List III of the LCD are so specific they don’t necessarily address these, specifically "pain." If my provider notes that a sebaceous cyst is painful/irritating to the patient, that is medical necessity according to the LCD, but none of the codes in List III are about pain or irritation in general. I don’t know how to code these so that Medicare will pay.
Any ideas? There used to be a Z code (if I remember right) that was a catch-all for medical necessity in these types of cases, but I don’t see it on the LCD anymore.