Question:
Devang Trivedi:
Hello Laureen/Alicia:
A malignant cutaneous lesion measuring 2.2 cm diameter in arm excised with 1 cm margin all side and made a intermittent closure performed. After a week physician thought to re-excise another 1 more cm from all side and perform same closure. Can you please guide me how to code this re-excision?
Regards.
Answer Thread:
Luna:
I'm not Alicia or Laureen, but your question is of interest to me because I just got through reading an article in this month's issue of the AAPC's Cutting Edge magazine. If you have that issue look to page 40.
Anyway, they do address "re-excisions". I will post a quote from the article here for you.
"Re-excision" Calls for Special Consideration
The physician may revisit a previous excision to remove additional material if pathology continues to show malignancy in the margins. How you report this depends on the timing of the follow-up excision.
If the re-excision occurs during the same session as the initial excision, report a single code to describe the greatest area removed. For example, if the first excision measures 3.0 cm with margins, and the second excision increased the margins by 1.0 cm on all sides, code for a 5.0 cm excision. Do not separately report a 3.0 cm excision and a 5.0 cm excision.
If the re-excision occurs during a subsequent session, however, base your code selection on the diameter of the new excision. For example, you report 11603 Excision, malignant lesion including margins, trunk, arms or legs; excised 2.1 to 3.0 cm for the initial excision on Tuesday. Pathology indicates inadequate margins to remove all malignancy. The physician returns the patient to the procedure room three days later (Friday) and increases the margin by 1 cm on all sides. You report Friday's session using 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm with modifier 58 Staged or related procedure or service by the same physician during the postoperative period appended because the re-excision occurred during the global period of the initial excision."
So, in your question, the original excision was 2.2 cm with 1.0 cm margins on arm. The excised diameter then is 4.2 and coded 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm
The re-excision though changes things. You now have previous excised diameter of 4.2 with additional 1.0 cm margin on all sides. So your new excised diameter is 6.2. The code is still 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm. How you code this will depend on whether this re-excision was during the initial session or was the patient returned on a subsequent day/session. If same session you will just code 11606. If subsequent visit, you would add modifier 58 as seen in the illustration provided in the AAPC article.
PS. If you are also wondering how to calculate the excised diameter using lesion size and margins there is another thread that addresses that.
https://www.cco.us/forum/threads/integumentary-system-subsection-question.1346/#post-4323
Devang Trivedi:
Thank you for the in-depth explanation, Luna. It helped me a lot.
Devang Trivedi:
Hello Laureen/Alicia:
A malignant cutaneous lesion measuring 2.2 cm diameter in arm excised with 1 cm margin all side and made a intermittent closure performed. After a week physician thought to re-excise another 1 more cm from all side and perform same closure. Can you please guide me how to code this re-excision?
Regards.
Answer Thread:
Luna:
Hi Devang Trivedi,
I'm not Alicia or Laureen, but your question is of interest to me because I just got through reading an article in this month's issue of the AAPC's Cutting Edge magazine. If you have that issue look to page 40.
Anyway, they do address "re-excisions". I will post a quote from the article here for you.
"Re-excision" Calls for Special Consideration
The physician may revisit a previous excision to remove additional material if pathology continues to show malignancy in the margins. How you report this depends on the timing of the follow-up excision.
If the re-excision occurs during the same session as the initial excision, report a single code to describe the greatest area removed. For example, if the first excision measures 3.0 cm with margins, and the second excision increased the margins by 1.0 cm on all sides, code for a 5.0 cm excision. Do not separately report a 3.0 cm excision and a 5.0 cm excision.
If the re-excision occurs during a subsequent session, however, base your code selection on the diameter of the new excision. For example, you report 11603 Excision, malignant lesion including margins, trunk, arms or legs; excised 2.1 to 3.0 cm for the initial excision on Tuesday. Pathology indicates inadequate margins to remove all malignancy. The physician returns the patient to the procedure room three days later (Friday) and increases the margin by 1 cm on all sides. You report Friday's session using 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm with modifier 58 Staged or related procedure or service by the same physician during the postoperative period appended because the re-excision occurred during the global period of the initial excision."
So, in your question, the original excision was 2.2 cm with 1.0 cm margins on arm. The excised diameter then is 4.2 and coded 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm
The re-excision though changes things. You now have previous excised diameter of 4.2 with additional 1.0 cm margin on all sides. So your new excised diameter is 6.2. The code is still 11606 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter over 4.0 cm. How you code this will depend on whether this re-excision was during the initial session or was the patient returned on a subsequent day/session. If same session you will just code 11606. If subsequent visit, you would add modifier 58 as seen in the illustration provided in the AAPC article.
PS. If you are also wondering how to calculate the excised diameter using lesion size and margins there is another thread that addresses that.
https://www.cco.us/forum/threads/integumentary-system-subsection-question.1346/#post-4323
Devang Trivedi:
Thank you for the in-depth explanation, Luna. It helped me a lot.