Sunday, September 11, 2011

67840 or 11440 - Which is the Right CPT CODE for Lesion Removals?

In a particular situation, your ophthalmologist takes off lesions from a patient's eyelids. While doing so, you may find yourself embroiled in a dilemma that you can solve only by assessing the physician's notes. You need to figure out whether the procedure is an integumentary procedure or an eyelid surgery procedure.

The answer determines whether you should turn over to codes 11440-11446 in your CPT manual or whether you should instead look at 67840. Your code selection depends on the number, location, type and size of the lesions. Take a look at these expert tips so that you make the right choice every time:

First step: You need to dig into your ophthalmologist's procedure documentation to figure out which code set you should go for. As a simple rule, you should go for 11440-11446 if the excision involves mainly skin.

To report 67840, see to it that the surgery involves more than the eyelid's skin. Say for instance, the procedure might involve lid margin, tarsus and/or palpebral conjunctiva.

Here's a CPT coding tip: Choose the proper lesion excision size code based on the report of the ophthalmologist. If the doctor does not measure the lesion before he cuts it out, he is bringing down the reimbursement in half.

Remember: Choosing the most appropriate CPT codes to describe the physician's work is the motivating factor behind your code assignment determination. As such, you should never base your code selection on reimbursement value.

Malignant in comparison to benign matters too

Step two: When your ophthalmology carries out an eyelid lesion excision that involves the eyelid mainly, you know you should go for the integumentary lesion excision codes.

The next question is which code in this section you should go for.

Well, for benign lesions, you should go for 11440-11446 while for malignant lesions you should turn to 11640-11646. Since a lesion's nature can be very deceptive based on the visual examination, you should always wait for the pathology report prior to billing the excision. Then choose your code based on the pathologic findings and the lesion size.

Bear in mind: You shouldn't use lesion excision and/or repair codes for skin tags. There are different codes for skin tag removal.

Multiple-lesion pitfalls to watch out for

Ophthalmologists will not always excise just one lesion at one go. As such you will face one more coding challenge when your physician does away with multiple lesions. Since 67840 is an excision code, which means you report it by the lid you can't report it with units – quite unlike the integumentary codes.