On this page · 8 sections
Part 1 of 5
Three ways to take tissue off
| Procedure | What's removed | Purpose | Codes |
|---|---|---|---|
| Biopsy | Part of the lesion, or a sample | Diagnosis | 11102–11107 |
| Shave removal | The whole lesion, sliced off horizontally; no full-thickness cut | Treatment | 11300–11313 |
| Excision | The whole lesion, full thickness, with margins | Treatment | 11400–11646 |
A tangential biopsy is also done "by shave," but it takes only a sample. Shave removal takes the entire lesion. Shave removal doesn't need sutures; control of bleeding (chemical or electrocautery) is included.
Site groups
All three families (shave, benign excision, malignant excision) use the same three site groups:
| Site group | Shave | Benign excision | Malignant excision |
|---|---|---|---|
| Trunk, arms, legs | 11300–11303 | 11400–11406 | 11600–11606 |
| Scalp, neck, hands, feet, genitalia | 11305–11308 | 11420–11426 | 11620–11626 |
| Face, ears, eyelids, nose, lips, mucous membrane | 11310–11313 | 11440–11446 | 11640–11646 |
Size steps
| Shave (lesion diameter) | Excision (excised diameter) |
|---|---|
| 0.5 cm or less | 0.5 cm or less |
| 0.6–1.0 cm | 0.6–1.0 cm |
| 1.1–2.0 cm | 1.1–2.0 cm |
| Over 2.0 cm | 2.1–3.0 cm |
| 3.1–4.0 cm | |
| Over 4.0 cm |
For example, trunk shave: 11300 (0.5 cm or less), 11301 (0.6–1.0), 11302 (1.1–2.0), 11303 (over 2.0). Trunk benign excision: 11400, 11401, 11402, 11403, 11404 and 11406 (there is no 11405).
Done: Shave, excise or biopsy?
Part 2 of 5
Excised diameter = lesion + margins
For excisions, the size is not just the lesion. It's the lesion's greatest clinical diameter plus the narrowest margin taken on each side.
| Lesion | Margin each side | Excised diameter |
|---|---|---|
| 2.0 cm | 0.2 cm | 2.0 + 0.2 + 0.2 = 2.4 cm |
| 0.9 cm | 0.3 cm | 0.9 + 0.3 + 0.3 = 1.5 cm |
| 1.0 cm | 0.2 cm | 1.0 + 0.2 + 0.2 = 1.4 cm |
Measure before the excision. A specimen measured by pathology after removal shrinks and shouldn't be used if the operative note gives the clinical measurements. If the note gives "total margins 0.6 cm," add 0.6 once.
One code per lesion, no adding together
Exception: if one excision takes out several lesions together (for example, one ellipse containing three nevi), that's one excision and one code (NCCI Policy Manual, ch. III, §E.1). Only one removal code is reported per lesion.
When the same code repeats, report units or separate lines as the payer requires. NCCI allows anatomic modifiers, 59 or XS to show different sites or lesions. If two different codes have no PTP edit, no modifier is needed. (A PTP modifier indicator of 9 doesn't mean "no edit"; it means an edit that was deleted or doesn't apply.)
Benign or malignant? Wait for pathology
Benign and malignant excisions use different codes, and the pathology report decides which applies. Hold the excision code until pathology is back; if it's malignant, use 11600–11646.
Modifier 22 can be added for an unusually difficult excision only when the note shows substantially more work or time than usual, and why.
Done: Excised diameter and the per-lesion rule
Part 3 of 5
Which closures are included?
| Closure after excision | Separately reportable? |
|---|---|
| Simple (single-layer) repair, strips, dressings | No, included in the excision |
| Intermediate (layered) repair | Yes, if medically necessary |
| Complex repair, adjacent tissue transfer, grafts | Yes, if medically necessary |
| Any repair after a benign excision of 0.5 cm or less (11400, 11420, 11440) | No, all repairs are included |
The last row comes from the NCCI Policy Manual (ch. III, §E.6). If one of several lesions is larger than 0.5 cm, an intermediate or complex repair of that larger lesion can still be reported.
Repairs are measured and coded separately (repair length in cm, by site group and type); the repair lesson covers that in detail.
Done: Repairs after excision
Part 4 of 5
Practice cases
Case 1 · shave, trunkTwo shave removals on the backOpen caseClose
Shave removal of two lesions from the back: 2.0 cm and 1.0 cm.
Your turn: code this case
Case 2 · shave, faceShave removals on the cheek, nose and lipOpen caseClose
Shave removal of three lesions: left cheek 0.4 cm, nose 0.8 cm, upper lip 0.5 cm.
Your turn: code this case
Case 3 · benign, with marginsEpidermal cyst, 2.0 cm, 0.2 cm margins, backOpen caseClose
Excision of a 2.0 cm lesion of the back with 0.2 cm margins. Pathology: epidermal inclusion cyst (benign). Simple closure.
Your turn: code this case
Case 4 · malignant, faceBasal cell carcinoma of the nose, 0.9 cm, 0.3 cm marginsOpen caseClose
Excision of a 0.9 cm lesion of the nasal ala with 0.3 cm margins. Pathology: basal cell carcinoma, margins clear.
Your turn: code this case
Case 5 · several benign lesionsThree benign excisions on the trunk: 2.4, 1.4 and 1.4 cmOpen caseClose
Three separate excisions on the trunk, excised diameters (with margins) 2.4 cm, 1.4 cm and 1.4 cm. Pathology: all benign nevi.
Your turn: code this case
Case 6 · several malignant lesionsThree malignant excisions on the trunk: 2.8, 1.8 and 1.0 cmOpen caseClose
Three separate excisions on the trunk, excised diameters 2.8 cm, 1.8 cm and 1.0 cm. Pathology: squamous cell carcinoma in all three.
Your turn: code this case
Done: Cases 1–6
Part 5 of 5
Case 7 · excision with intermediate repairBenign 2.4 cm excision of the back, layered closure 3.0 cmOpen caseClose
Excision of a benign lesion of the back, excised diameter 2.4 cm. The defect is closed in layers (subcutaneous and skin), repair length 3.0 cm.
Your turn: code this case
Case 8 · small benign excision with repairBenign 0.4 cm excision of the eyebrow, layered closureOpen caseClose
Excision of a benign lesion of the eyebrow, excised diameter 0.4 cm, with a layered (intermediate) closure.
Your turn: code this case
Case 9 · one excision, several lesionsThree nevi removed in one ellipseOpen caseClose
A single elliptical excision on the upper arm removes three adjacent nevi together; excised diameter 3.2 cm. Pathology: benign.
Your turn: code this case
Case 10 · pathology pendingExcision coded before the pathology reportOpen caseClose
Excision of a 1.2 cm lesion of the scalp with 0.3 cm margins. The note says "rule out melanoma." Pathology isn't back yet.
Your turn: code this case
Case 11 · biopsy and excisionPunch biopsy of one lesion, excision of anotherOpen caseClose
Punch biopsy of a lesion on the left forearm, and excision of a different lesion on the back (benign, excised diameter 1.6 cm).
Your turn: code this case
Case 12 · shave vs. excisionFull-thickness removal with margins, documented as 'shave'Open caseClose
The note heading says "shave removal," but the body documents a full-thickness elliptical excision into subcutaneous fat with 0.2 cm margins of a 1.0 cm benign lesion of the thigh, closed with a simple repair.
Your turn: code this case
Done: Cases 7–12