Lesion Excision With Same-Day Wound Repair and Multiple Sites
A 58-year-old woman undergoes excision of three skin lesions in an ambulatory surgery center under local anesthesia. Site 1: left cheek, benign-appearing lesion, excised diameter 2.1 cm including margins; pathology returns benign. Site 2: right shoulder, lesion excised diameter 0.9 cm including margins; pathology returns benign. Site 3: mid-back, lesion excised diameter 1.4 cm including margins; pathology returns benign. After the cheek excision, the surgeon closed the defect with a layered intermediate repair (subcutaneous plus skin) measuring 3.2 cm. The shoulder and back defects were closed with simple single-layer repairs (1.0 cm and 1.6 cm respectively). The operative note documents all three excisions and all three repairs. The patient has commercial insurance; medical necessity is documented for each lesion.
1. Determine the correct excision codes and repair codes, and explain how the repairs should be reported relative to the excisions.
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Excisions (benign, by site and size including margins):
- Cheek 2.1 cm → benign excision, face, 2.0–3.0 cm → 11443 (benign, face, 2.0–3.0 cm).
- Shoulder 0.9 cm → benign, trunk/arms/legs, 0.6–1.0 cm → 11402.
- Back 1.4 cm → benign, trunk/arms/legs, 1.1–2.0 cm → 11403.
Note that benign excision codes are selected by the excised diameter including margins, and the site category (face vs trunk/arms/legs) determines the code family. The face category is not "head/neck" broadly - it is specifically face/ears/eyelids/nose/lips, so cheek correctly falls into the face family.
Repairs:
- Cheek: intermediate repair, face → 3.2 cm → 12053 (intermediate repair, face/ears/eyelids/nose/lips, 2.6–5.0 cm).
- Shoulder: simple repair, 1.0 cm, trunk → 12001 (simple, head/neck/trunk/arms/legs, ≤2.5 cm).
- Back: simple repair, 1.6 cm, trunk → 12002 (simple, same category, 2.6–7.5 cm) - wait, 1.6 cm falls in ≤2.5 cm, so it is also 12001.
Key judgement: Repairs are separately reportable with excisions when a layered (intermediate or complex) repair is performed and documented. Simple single-layer closures are considered integral to the excision and are not separately reported. Therefore:
- Cheek: report 11443 AND 12053 (intermediate repair is separately payable).
- Shoulder: report 11402 only; the simple repair is bundled.
- Back: report 11403 only; the simple repair is bundled.
Add modifier 51 (or payer-preferred equivalent) to the secondary procedure on the same date if the payer requires it, and ensure the intermediate repair is supported by documentation of layered closure.
2. The coder is told by a colleague that because three lesions were removed, the repair codes should be summed by category into a single repair code. Evaluate this advice.
Read the worked answer
The advice is incorrect. Repair codes are selected per wound/defect, not by summing lengths across separate anatomic sites. Each wound is coded individually based on its own repair type and length, and multiple repairs are reported as separate line items. Summing lengths across different sites (e.g., cheek + shoulder + back) would inappropriately combine unrelated wounds into one code and would misrepresent the service.
Additionally, the repair type must match: simple repairs are bundled into the excision and therefore not separately reported at all here. Only the intermediate cheek repair stands alone as a separately reportable repair.
So the correct reporting is: 11443 and 12053 for the cheek (with appropriate modifier per payer), 11402 for the shoulder, and 11403 for the back. No summation of repair lengths is performed.