"To report the removal of skin lesions, the method of removal, size and location of the lesion, and whether the tissue was benign or malignant are the crucial elements needed to select the proper CPT code . There may be variation, however, among local payers regarding the modifiers that are used for reporting the removal of multiple lesions.
Three Methods of Removal
There are numerous types of skin lesions and a variety of ways to remove them. But there are three methods of removal that internists primarily employ:
1. Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal or dermal lesions without a full-thickness dermal excision, according to CPT. The descriptions of the codes for shaving (11300-11313) all include local anesthesia and chemical or electrocauterization to close the wound.
2. Excision is defined as the full-thickness (through the dermis) removal of a lesion, according to CPT. Local anesthesia and a simple (non-layered) closure are included in the descriptions of both the excision of benign lesion codes (11400-11446) and the excision of malignant lesion codes (11600-11646).
3. Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement. This could include electrosurgery, cryosurgery, laser or chemical treatment. Lesions that might be removed in this manner include condylomata, papillomata, molluscum, contagiosum, herpetic lesions, warts, milia, or other benign, premalignant (e.g., actinic keratoses) or malignant lesions. Local anesthesia is included in the description of the codes for the destruction of benign or premalignant lesions (17000-17250) and malignant lesions (17260-17286).