What are the CPT (Current Procedural Terminology) codes and RVUs (Relative Value Units) for lesion excision and lipoma excision?

CPT Codes and RVUs for Lesion and Lipoma Excision

Lesion excision and lipoma excision are coded using CPT codes 11400-11446 (for benign lesions including lipomas) and 11600-11646 (for malignant lesions), with code selection based on anatomic location and the sum of the lesion diameter plus narrowest required margin measured prior to excision. 1

CPT Code Selection Principles

Measurement Requirements

• Measure the lesion's greatest clinical diameter plus the narrowest margin required for adequate excision BEFORE making the incision 1
• The measurement is based on the physician's clinical judgment of what margin is necessary 1
• Only the more complex procedure may be billed if multiple removal techniques are attempted during the same session 1

Code Categories by Lesion Type

Benign Lesions (including lipomas): CPT 11400-11446 1

• Organized by anatomic site (trunk/arms/legs, scalp/neck/hands/feet/genitalia, face/ears/eyelids/nose/lips/mucous membranes)
• Size ranges: 0.5 cm or less, 0.6-1.0 cm, 1.1-2.0 cm, 2.1-3.0 cm, 3.1-4.0 cm, >4.0 cm

Malignant Lesions: CPT 11600-11646 1

• Same anatomic site organization as benign codes
• Same size range categories

Definition of Excision

CPT defines excision as "full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed" 1

What's Included in the Base Code

• Full-thickness removal through the dermis 1
• Necessary margins 1
• Simple (non-layered) closure 1

When Additional Codes Apply

• Complex or layered closures require separate coding - the excision code only covers simple closure 1
• Intermediate or complex repairs should be coded separately when performed 1

RVU Considerations

Documentation Requirements for Maximum Reimbursement

• Document the pre-excision measurement of lesion plus margin 1
• Specify anatomic location precisely 1
• Note whether closure was simple, intermediate, or complex 1
• Detailed documentation is crucial for capturing full allowable reimbursement, especially when procedures involve more than simple closure 1

Common Coding Discrepancies

• Professional coders frequently add distinct codes that surgeons miss, with studies showing a 161% increase in total codes submitted by professional coders versus original surgeon-derived codes 2
• The most common source of change is the addition of distinct codes by billing professionals (54.51% of cases) 2
• Accurate CPT coding is crucial for appropriate compensation and compliance with Medicare policies 3

Special Considerations for Lipomas

Surgical Approach Impact on Coding

• Complete en-bloc excision is the standard treatment for symptomatic lipomas 4
• The standard surgical procedure is wide excision with negative margins (R0), removing the tumor with a rim of normal tissue 4
• Minimally invasive techniques (such as the 2.5-cm incision method) are still coded as excisions if full-thickness removal is achieved 5

Size-Based Coding

• Large lipomas (>5 cm diameter) are coded based on the total measurement of lesion plus margin, not the incision size 1
• The actual incision length does not determine the code - the pre-excision measurement does 1

Critical Documentation Pitfalls to Avoid

• Never document only the incision size - you must record the pre-excision lesion diameter plus margin 1
• Don't bill for both a less invasive attempt and the definitive excision if performed in the same session - only code the more complex procedure 1
• Avoid selecting codes based on post-excision pathology measurements - use pre-excision clinical measurements 1
• Erroneous coding may result in loss of revenues and/or significant monetary penalties 3

Multidisciplinary Approach

A multidisciplinary approach involving both surgeons and professional coders appears to be the best way to achieve coding accuracy 3. However, surgeons should verify codes at sign-out or through post-sign-out auditing to ensure accuracy 3.