Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.
Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?
Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, MD, FACS, with the American College of Surgeons in “Excision of Soft Tumors/Bone Tumors” on the final day of the AMA CPT and RBRVS 2010 Annual Symposium. The size of the lesion is the lesion. “The defining size is the size of the resection” or the mass that’s taken out, Bothe stressed.
If all that the surgeon takes out is the lesion, you would use the lesion size or 2 cm as the lesion excision. But if the surgeon indicates the larger size of the tissue he also has to take out, you assign the excision code based on the resection size. You mention that the resection size is 4 cm, which is more than the 3-cm cut point stipulated in 27327’s new 2010 description (Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm). Therefore, you would use 27337 (… 3 cm or greater). Don’t miss this documentation must …
Call your surgeon’s attention to the greater burden of documentation the new musculoskeletal tumor excision codes require, Bothe recommends. “If the surgeon documents just the size of the lesion and not the resection size, you could end up with a lower code.”
“The best time for the surgeon to indicate the resection’s size is when he’s doing the removal,” points out John P. Heiner, MD, with the American Academy of Orthopedic Surgeons. If the taken out material’s size is based on the pathology report, you will have a lower measurement. The mass shrinks when put in preservative for specimen handling.
— by Jennifer Godreau
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