Coding and Compliance: Report Repairs with Ease


Coding for lesion excision is not always easy and you must choose your lesion excision codes wisely. Read this expert medical billing and coding training article on how to report repairs correctly.

Suppose there are simple repairs with the scalp, neck, axillae, external genitalia, et cetera, they're broken down like 2.5 or less and then 2.6 to 7.5 cm. But then when you look at a different body area, let's say, ears, eye lids, nose, et cetera, they break that middle section down into two other sections.

So, they have 2.5 or less, then 2.6 to 5.0 and then 5.1 to 7.5. So, they kind of make different sizes in there because of where the structures are. Anytime you see the trunk and the extremities not including the hands and the feet, the trunk and the extremities are considered like non-special areas whereas the face and the hands, those are considered special areas because of the vasculature and just the cosmetic issue and the healing issue.

It's a little bit different in those structures so those are considered special areas. And those carry a higher RVU value to them according the medical coding guidelines. So sometimes, they break them up a little bit differently.

Also with the repairs, you need to be careful with those because they change the groupings a little bit too. Simple bundles in the hands and the feet into the trunk. But with the intermediate it excludes out the hands and the feet and puts them in a different category.

So, also really look at the body area to make sure you're getting the right body area for what's being done.

Medical Coding Example: if they're a 3.6 cm simple on the abdomen, a 5.2 cm simple on the back and a 2.8 simple on the chest, because they're all the same kind, they're all simple and they're all under the same grouping of the trunk and extremities, you would add them together as one 11.6 cm repair and that would be CPT code 12004.

So, just be mindful, it has to be both though to add them together. But if they're not, then the more complicated. So, the complex ones would be listed first. It's not by size. It's about complexity at that point as per the medical coding guidelines.

The excisions of the lesion, the shaves of the lesion, the repairs, the ATTs, all of these, that you try to get them on one template so that way, the physician doesn't have to pull like three different templates depending on what they're doing. They can pull one and use it all off one. The easier we can make it for them to use, the more apt they are to use it and use it correctly. And once they start using it every time and see how it helps them; it might not be so hard.

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