L29170

LCD/NCD Portal

Automated World Health

L29170

EXCISION OF MALIGNANT SKIN LESIONS

10/01/2011

Indications and Limitations of Coverage and/or Medical Necessity

• Four of the most common methods of treatment of malignant skin lesions are:

o Surgical excision

o Electrodessication (tissue destruction by heat)

o Radiation therapy

o Cryosurgery (tissue destruction by freezing)

• The treatment of choice for malignant skin lesions is complete excision that includes a variable margin of surrounding tissue in order to eradicate microscopic tumor cells, which may have spread beyond the visible borders of the lesion.

• Medicare will consider the excision of a malignant skin lesion including margins (procedure codes 11600-11646) medically necessary when a pathology report verifies the existence of a malignancy.

• When a lesion is excised that is a neoplasm of uncertain morphology (e.g., melanoma vs. dyplastic nevi), choose the correct CPT code based on the manner in which the lesion is excised rather than the final pathological diagnosis.

o The CPT code should reflect the knowledge, skill, time and effort that the provider invests in the excision of the lesion.

o For example, an ambiguous, but low-suspicion lesion might be excised with minimal surrounding, grossly normal skin/soft tissue margins, as for a benign lesion.

o This would be most appropriately reported using the excision of benign lesion codes 11400-11446.

o An ambiguous, but moderate to high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion.

o This type of excision would be most appropriately reported using the excision of malignant lesion including margins codes 11600-11646.

CPT/HCPCS Codes

11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS

11601 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM

11602 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM

11603 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM

11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM

11606 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM

11620 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS

11621 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM

11622 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM

11623 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM

11624 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM

11626 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM

11640 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.5 CM OR LESS

11641 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.6 TO 1.0 CM

11642 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM

11643 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 2.1 TO 3.0 CM

11644 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 3.1 TO 4.0 CM

11646 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER OVER 4.0 CM

ICD-9 Codes that Support Medical Necessity

Procedure Codes 11600-11606

172.5 MALIGNANT MELANOMA OF SKIN OF TRUNK EXCEPT SCROTUM

172.6 MALIGNANT MELANOMA OF SKIN OF UPPER LIMB INCLUDING SHOULDER

172.7 MALIGNANT MELANOMA OF SKIN OF LOWER LIMB INCLUDING HIP

173.50 UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF TRUNK, EXCEPT SCROTUM

173.51 BASAL CELL CARCINOMA OF SKIN OF TRUNK, EXCEPT SCROTUM

173.52 SQUAMOUS CELL CARCINOMA OF SKIN OF TRUNK, EXCEPT SCROTUM

173.59 OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF TRUNK, EXCEPT SCROTUM

173.60 UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

173.61 BASAL CELL CARCINOMA OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

173.62 SQUAMOUS CELL CARCINOMA OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

173.69 OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

173.70 UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP

173.71 BASAL CELL CARCINOMA OF SKIN OF LOWER LIMB, INCLUDING HIP

173.72 SQUAMOUS CELL CARCINOMA OF SKIN OF LOWER LIMB, INCLUDING HIP

173.79 OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP

195.1 MALIGNANT NEOPLASM OF THORAX

195.2 MALIGNANT NEOPLASM OF ABDOMEN

195.3 MALIGNANT NEOPLASM OF PELVIS

195.4 MALIGNANT NEOPLASM OF UPPER LIMB

195.5 MALIGNANT NEOPLASM OF LOWER LIMB

195.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES

198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN

198.81 SECONDARY MALIGNANT NEOPLASM OF BREAST

232.5 CARCINOMA IN SITU OF SKIN OF TRUNK EXCEPT SCROTUM

232.6 CARCINOMA IN SITU OF SKIN OF UPPER LIMB INCLUDING SHOULDER

232.7 CARCINOMA IN SITU OF SKIN OF LOWER LIMB INCLUDING HIP

232.8 CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN

238.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN

Procedure Codes 11620-11626

172.4 MALIGNANT MELANOMA OF SKIN OF SCALP AND NECK

172.6 MALIGNANT MELANOMA OF SKIN OF UPPER LIMB INCLUDING SHOULDER

172.7 MALIGNANT MELANOMA OF SKIN OF LOWER LIMB INCLUDING HIP

173.40 UNSPECIFIED MALIGNANT NEOPLASM OF SCALP AND SKIN OF NECK

173.41 BASAL CELL CARCINOMA OF SCALP AND SKIN OF NECK

173.42 SQUAMOUS CELL CARCINOMA OF SCALP AND SKIN OF NECK

173.49 OTHER SPECIFIED MALIGNANT NEOPLASM OF SCALP AND SKIN OF NECK