How Depth Affects Excision Claims

Depth is very important when choosing the appropriate code for coding excision claims. For example, a surgeon excises a lipoma from a patient’s back, and the excision measures 5.0 cm x 4.0 cm x 2.0 cm. In this situation, should you select code 21930 or code 11406 for the procedure that was performed? The key to deciding which code is the correct code is the depth of the excision that the physician performed on the patient. Assuming that the depth, in this example, is 2.0 cm (20mm), is much greater than the average thickness of the skin (2-3mm), so you are justified to report code 21930 (which is excision, tumor, soft tissue of back or flank).

Lipomas are usually found below the skin, and some varieties might be quite deep, such as sub-fascial/intramuscular lipomas. However, skin lipomas do exist. You should rely on benign lesion codes (such as 11406 for excision of benign lesions diameter over 4.0 cm) for cases in which the physician’s documentation describes a skin lipoma. When the depth is greater, such as in sub-fascial/intramuscular lipomas, then you should use code 21930, because the depth is significantly greater than the average depth of the skin. As you can see, the depth of the excision is very important when choosing the proper code for excision claims. Pay close attention to the physician documentation when coding these types of claims to determine the type and depth, and choose the appropriate code based on that information.

View all Articles by: Kathryn E, CCS-P - Retired