Resolved Integumentary System Subsection Question

[RinshidaK_89540]

Question:
Janice White
If the surgeon documents a malignant lesion is 2 CM X 3.2 CM with 3 MM Margins excised from the left shin with a complex repair. How do we figure out the size for the multi-deminsions plus the margins?
Thanks, Janice

Answer thread:
Luna
I think you would first convert the mm to cm. So 3 mm would be 0.3 cm.

Then you take 0.3 and multiply it by two because that margin will be at each end of the diameter of the lesion. (Too bad I can't draw a picture here.) Anyway, you get 0.6. for the margins.

Then you add that to your lesion measurement. 2 cm + 0.6 cm= 2.6 cm; 3.2 cm + 0.6 cm= 3.8 cm. So your complete dimension of lesion plus margins is: 2.6 cm X 3.8 cm.

Is that what you were looking for?
Luna
Coming back to review my answer, I didn't know if you might also be wondering then which measurement (2.6cm or 3.8cm) was used for finding the appropriate CPT code. In case you were wondering, the guidelines say: "Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision."

So, that would be the 3.8 cm. (3.2 cm being the greatest dimension of the lesion plus 0.6 cm margins.) So then you would code an Excision-Malignant Lesion of the legs with the code that includes 3.8 cm. In this case, I'm thinking 11604.
Carolyn Heath
If you have 2013 CPT Professional Edition, there is a diagram on page 66 (Pg 92 of 2024 CPT edition) that tells you how to measure and code the removal of a lesion. Example B shows you how to figure out the multiple measurements. You add the margins: 0.3 + 0.3 = 0.6. Then you are going to multiply 2 cm by 3.2 cm: 2.0 x 3.2 = 6.4. Add: 0.6 + 6.4 = 7 cm. The code for the malignant removal of the lesion is 11606. The code for the complex repair is 13101.
Luna

If you have 2013 CPT Professional Edition, there is a diagram on page 66 that tells you how to measure and code the removal of a lesion. Example B shows you how to figure out the multiple measurements. You add the margins: 0.3 + 0.3 = 0.6. Then you are going to multiply 2 cm by 3.2 cm: 2.0 x 3.2 = 6.4. Add: 0.6 + 6.4 = 7 cm. The code for the malignant removal of the lesion is 11606. The code for the complex repair is 13101.

I'm failing to see in those illustrations that we are supposed to square (multiply) the dimension of the lesion and then add the margins? Are you sure we're supposed to do that (2.0 x 3.2)?

Carolyn Heath
If you look at Example B on page 66 (2013 CPT Professional Edition) (Pg 92 of 2024 CPT edition), the excision is for a benign lesion of the neck, 1.0 cm by 2.0 cm. You are going to add the two margins which is 0.2 cm (0.2 + 0.2 = 0.4). Then you multiply the lesion (2.0 x 1.0 = 2.0 ). To get the excised diameter, you will add lesion and margins together (2.0 cm + 0.4 cm = 2.4 cm). This formula works for both the benign and malignant lesions. So, to answer your question, you do have to multiply the lesions and add the margins. Remember to add the sums of the lesions and margins together to get the measurement and the right code for the lesion.

Luna

If you look at Example B on page 66 (2013 CPT Professional Edition), the excision is for a benign lesion of the neck, 1.0 cm by 2.0 cm. You are going to add the two margins which is 0.2 cm (0.2 + 0.2 = 0.4). Then you multiply the lesion (2.0 x 1.0 = 2.0 ). To get the excised diameter, you will add lesion and margins together (2.0 cm + 0.4 cm = 2.4 cm). This formula works for both the benign and malignant lesions. So, to answer your question, you do have to multiply the lesions and add the margins. Remember to add the sums of the lesions and margins together to get the measurement and the right code for the lesion.

Sorry, I just thought the note to the left of the illustration ("2.0 cm x 1.0 cm" benign lesion"), was just saying that the lesion was 2 centimeters by 1 centimeter. I did not interpret that it was saying to multiply the dimensions of the lesion.

I also just got out my Blitz and watched Laureen explain how to figure the dimension of a lesion and its margin and then selecting the appropriate code from the correct "location, location, location" bubble. (I love how Laureen emphasizes things like that. )

So, in Laureen's explanation, she does not multiply the dimensions of the lesion. If it is an oval shaped lesion, or a lesion having multiple dimensions, she explains that you take the largest diameter and add the margin to it twice. So, in the question above, our guest would take 3.2 cm and add .3 cm to it twice, because a .3 cm margin would be at both ends of the lesion. That gives you 3.8.

So then she would find the code for the correct location that includes 3.8 in it's size range. The correct code for this lesion would be 11406. And then as you said Carolyn, you would also need to code the complex repair.

But, I'm certain you don't multiply the dimensions of the lesion.

Luna

Sorry, I just thought the note to the left of the illustration ("2.0 cm x 1.0 cm" benign lesion"), was just saying that the lesion was 2 centimeters by 1 centimeter. I did not interpret that it was saying to multiply the dimensions of the lesion.

I also just got out my Blitz and watched Laureen explain how to figure the dimension of a lesion and its margin and then selecting the appropriate code from the correct "location, location, location" bubble. (I love how Laureen emphasizes things like that. )

So, in Laureen's explanation, she does not multiply the dimensions of the lesion. If it is an oval shaped lesion, or a lesion having multiple dimensions, she explains that you take the largest diameter and add the margin to it twice. So, in the question above, our guest would take 3.2 cm and add .3 cm to it twice, because a .3 cm margin would be at both ends of the lesion. That gives you 3.8.

So then she would find the code for the correct location that includes 3.8 in it's size range. The correct code for this lesion would be 11406. And then as you said Carolyn, you would also need to code the complex repair.

But, I'm certain you don't multiply the dimensions of the lesion.

Oops. Typo. I accidentally typed 11406. SHOULD BE 11604, same as in my first reply up above. Sorry about any confusion that may have caused.

Carolyn Heath
I don't know to do it that way. I just follow the examples in the CPT manual.

Lori Woods
Hey I don't know if this helps, but I found this diagram in the Step By Step Carol Buck textbook

Luna

I don't know to do it that way. I just follow the examples in the CPT manual.

The way the Blitz explains does follow the example in the CPT manual. I just think you are confusing the 2.0 cm x by 1.0 cm note in the diagram to mean "multiply" and stead of to mean that the lesion in the diagram is 2 centimeters by 1 centimeter. The only reason it's working for you in this case is because 1 is part of the diagrams equation.

If the diagram actually read 2.0 cm x 3.0 cm, I think it would mean the lesion is 2 centimeters by 3 centimeters; not to multiply for a diameter of 6 cm.

In fact, if you look to example C of the diagrams, there is another multi-dimensional lesion. They only provide the greatest side in the measurement note on the left. It is 0.9 at the greatest distance of the lesion. They didn't provide the narrowest measurement. Wouldn't that equation be necessary if you have to multiply the dimensions? It looks like they took the greatest measurement of the lesion, 0.9 and added that to the margin, 0.3 twice to get an excised diameter of 1.5.

So, I'm pretty sure, that the "x" in the measurement note is not saying to multiply the two measurements. It's just saying that the lesion is such-n-such by such-n-such a size.

It would be important to know that for sure because it could make a big difference in code choice.

Lori Woods
http://www.surgistrategies.com/arti...r-removal-of-benign-and-malignant-skin-l.aspx
(https://www.cco.community/threads/integumentary-surgery-2024-cpt-bhat-tm-video.8982/)

 

[RinshidaK_89540]

Question:
Janice White
If the surgeon documents a malignant lesion is 2 CM X 3.2 CM with 3 MM Margins excised from the left shin with a complex repair. How do we figure out the size for the multi-deminsions plus the margins?
Thanks, Janice

Answer thread:
Luna
I think you would first convert the mm to cm. So 3 mm would be 0.3 cm.

Then you take 0.3 and multiply it by two because that margin will be at each end of the diameter of the lesion. (Too bad I can't draw a picture here.) Anyway, you get 0.6. for the margins.

Then you add that to your lesion measurement. 2 cm + 0.6 cm= 2.6 cm; 3.2 cm + 0.6 cm= 3.8 cm. So your complete dimension of lesion plus margins is: 2.6 cm X 3.8 cm.

Is that what you were looking for?
Luna
Coming back to review my answer, I didn't know if you might also be wondering then which measurement (2.6cm or 3.8cm) was used for finding the appropriate CPT code. In case you were wondering, the guidelines say: "Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision."

So, that would be the 3.8 cm. (3.2 cm being the greatest dimension of the lesion plus 0.6 cm margins.) So then you would code an Excision-Malignant Lesion of the legs with the code that includes 3.8 cm. In this case, I'm thinking 11604.
Carolyn Heath
If you have 2013 CPT Professional Edition, there is a diagram on page 66 (Pg 92 of 2024 CPT edition) that tells you how to measure and code the removal of a lesion. Example B shows you how to figure out the multiple measurements. You add the margins: 0.3 + 0.3 = 0.6. Then you are going to multiply 2 cm by 3.2 cm: 2.0 x 3.2 = 6.4. Add: 0.6 + 6.4 = 7 cm. The code for the malignant removal of the lesion is 11606. The code for the complex repair is 13101.
Luna


I'm failing to see in those illustrations that we are supposed to square (multiply) the dimension of the lesion and then add the margins? Are you sure we're supposed to do that (2.0 x 3.2)?

Carolyn Heath
If you look at Example B on page 66 (2013 CPT Professional Edition) (Pg 92 of 2024 CPT edition), the excision is for a benign lesion of the neck, 1.0 cm by 2.0 cm. You are going to add the two margins which is 0.2 cm (0.2 + 0.2 = 0.4). Then you multiply the lesion (2.0 x 1.0 = 2.0 ). To get the excised diameter, you will add lesion and margins together (2.0 cm + 0.4 cm = 2.4 cm). This formula works for both the benign and malignant lesions. So, to answer your question, you do have to multiply the lesions and add the margins. Remember to add the sums of the lesions and margins together to get the measurement and the right code for the lesion.

Luna


Sorry, I just thought the note to the left of the illustration ("2.0 cm x 1.0 cm" benign lesion"), was just saying that the lesion was 2 centimeters by 1 centimeter. I did not interpret that it was saying to multiply the dimensions of the lesion.

I also just got out my Blitz and watched Laureen explain how to figure the dimension of a lesion and its margin and then selecting the appropriate code from the correct "location, location, location" bubble. (I love how Laureen emphasizes things like that. )

So, in Laureen's explanation, she does not multiply the dimensions of the lesion. If it is an oval shaped lesion, or a lesion having multiple dimensions, she explains that you take the largest diameter and add the margin to it twice. So, in the question above, our guest would take 3.2 cm and add .3 cm to it twice, because a .3 cm margin would be at both ends of the lesion. That gives you 3.8.

So then she would find the code for the correct location that includes 3.8 in it's size range. The correct code for this lesion would be 11406. And then as you said Carolyn, you would also need to code the complex repair.

But, I'm certain you don't multiply the dimensions of the lesion.

Luna

Oops. Typo. I accidentally typed 11406. SHOULD BE 11604, same as in my first reply up above. Sorry about any confusion that may have caused.

Carolyn Heath
I don't know to do it that way. I just follow the examples in the CPT manual.

Lori Woods
Hey I don't know if this helps, but I found this diagram in the Step By Step Carol Buck textbook

Luna


The way the Blitz explains does follow the example in the CPT manual. I just think you are confusing the 2.0 cm x by 1.0 cm note in the diagram to mean "multiply" and stead of to mean that the lesion in the diagram is 2 centimeters by 1 centimeter. The only reason it's working for you in this case is because 1 is part of the diagrams equation.

If the diagram actually read 2.0 cm x 3.0 cm, I think it would mean the lesion is 2 centimeters by 3 centimeters; not to multiply for a diameter of 6 cm.

In fact, if you look to example C of the diagrams, there is another multi-dimensional lesion. They only provide the greatest side in the measurement note on the left. It is 0.9 at the greatest distance of the lesion. They didn't provide the narrowest measurement. Wouldn't that equation be necessary if you have to multiply the dimensions? It looks like they took the greatest measurement of the lesion, 0.9 and added that to the margin, 0.3 twice to get an excised diameter of 1.5.

So, I'm pretty sure, that the "x" in the measurement note is not saying to multiply the two measurements. It's just saying that the lesion is such-n-such by such-n-such a size.

It would be important to know that for sure because it could make a big difference in code choice.

Lori Woods
http://www.surgistrategies.com/arti...r-removal-of-benign-and-malignant-skin-l.aspx
(https://www.cco.community/threads/integumentary-surgery-2024-cpt-bhat-tm-video.8982/)

Answer Thread:
Lori Woods

Answer: When calculating lesion excision size for coding purposes, you’re selling yourself short if you just measure the lesion. For optimal return on your coding, report the total excised diameter on the claim.

How? First, find out the lesion’s exact size. Per CPT, code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (i.e., excision diameter plus the narrowest margins required equals the excised diameter).

Suppose the ED physician treats a lesion on the patient’s left leg. The operative report indicates that the lesion was benign. The lesion was 2.6 cm at its widest point, and the ED physician also had to remove a margin of 0.3 cm on either side of the lesion.

To come up with total excised diameter, add the lesion diameter (2.6 cm) and the margin (0.3 cm + 0.3 cm), and the total diameter would be 3.2 cm.

Lori Woods

I agree it is 3.8 sorry you code the greatest with the margins like the photo.

Carolyn Heath

What page is it in the Carol Buck book? Thanks for the link, Lori!

Carolyn Heath
Thank you, Lori! I finally got it. After working on this problem for the past 4 hours, I got the answer everyone was talking about. Here is how I figured it out: You multiply the 2 cm by 0.3 mm (2 X 0.3 = 0.6). Then you add the 3.2 to 0.6 (3.2 + 0.6). The answer is 3.8. The code for the excision of the malignant lesion will be 11604 and the code for complex repair will be 13101. I found a link that helped me figured it out: http://generalsurgerynews.com/ViewArticle.aspx?d_id=65&a_id=3799.(https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-3.pdf)

Luna

Thank you, Lori! I finally got it. After working on this problem for the past 4 hours, I got the answer everyone was talking about. Here is how I figured it out: You multiply the 2 cm by 0.3 mm (2 X 0.3 = 0.6). Then you add the 3.2 to 0.6 (3.2 + 0.6). The answer is 3.8. The code for the excision of the malignant lesion will be 11604 and the code for complex repair will be 13101. I found a link that helped me figured it out: http://generalsurgerynews.com/ViewArticle.aspx?d_id=65&a_id=3799 (https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-3.pdf)

Well, you got the right final equation right. But again, if the numbers were different, the way you figured it would result in an incorrect size and possibly and incorrect code.

In your explanation, you took the narrowest diameter (2 cm) and multiplied it by the margin (0.3 cm). This would result in an incorrect code. You want to take the margin and add it to itself (or multiply it by two), because it is at each end of the lesion. Then take that sum and add it to the largest diameter, the 3.2 cm.

So, let's say an excised lesion was 2.5 cm by 3 cm with a 5 mm margin (0.5 cm).
You would take 3 cm (the largest diameter) and add 0.5 cm to it twice. (Or mulitply 0.5 x2 and add to 3 cm.)
3 + 0.5 + 0.5 = 4 cm. (Or 0.5 x 2= 1.0 + 3 = 4 cm) You would then code the 4 cm to the proper location.

If you did it by the way you explained you would get an entirely different answer. If you actually took the narrowest diameter (2.5 cm) and multiplied it by the margin (0.5 cm) and added that to the largest diameter (3 cm) you would get: 2.5 x 0.5 = 1.25 + 3= 4.25 Doing it that way could end up with an incorrect code.

Just remember, that if the document gives you a such-n-such size lesion, the only number in it that matters to finding the correct code is going to be the largest side of the lesion and the margin.

If it is a 2 cm x 3.2 cm lesion with 0.3 cm margins, the only numbers you are going to work with are the 3.2 and adding 0.3 to it twice.
If it is 2 cm x 2 cm with 0.5 cm margins, you are only going to take 2 and add 0.5 to it twice.

Hope that helps.

 

[RinshidaK_89540]

Answer Thread:
Lori Woods

Answer: When calculating lesion excision size for coding purposes, you’re selling yourself short if you just measure the lesion. For optimal return on your coding, report the total excised diameter on the claim.

How? First, find out the lesion’s exact size. Per CPT, code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (i.e., excision diameter plus the narrowest margins required equals the excised diameter).

Suppose the ED physician treats a lesion on the patient’s left leg. The operative report indicates that the lesion was benign. The lesion was 2.6 cm at its widest point, and the ED physician also had to remove a margin of 0.3 cm on either side of the lesion.

To come up with total excised diameter, add the lesion diameter (2.6 cm) and the margin (0.3 cm + 0.3 cm), and the total diameter would be 3.2 cm.

Lori Woods

I agree it is 3.8 sorry you code the greatest with the margins like the photo.

Carolyn Heath

What page is it in the Carol Buck book? Thanks for the link, Lori!

Carolyn Heath
Thank you, Lori! I finally got it. After working on this problem for the past 4 hours, I got the answer everyone was talking about. Here is how I figured it out: You multiply the 2 cm by 0.3 mm (2 X 0.3 = 0.6). Then you add the 3.2 to 0.6 (3.2 + 0.6). The answer is 3.8. The code for the excision of the malignant lesion will be 11604 and the code for complex repair will be 13101. I found a link that helped me figured it out: http://generalsurgerynews.com/ViewArticle.aspx?d_id=65&a_id=3799.(https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-3.pdf)

Luna


Well, you got the right final equation right. But again, if the numbers were different, the way you figured it would result in an incorrect size and possibly and incorrect code.

In your explanation, you took the narrowest diameter (2 cm) and multiplied it by the margin (0.3 cm). This would result in an incorrect code. You want to take the margin and add it to itself (or multiply it by two), because it is at each end of the lesion. Then take that sum and add it to the largest diameter, the 3.2 cm.

So, let's say an excised lesion was 2.5 cm by 3 cm with a 5 mm margin (0.5 cm).
You would take 3 cm (the largest diameter) and add 0.5 cm to it twice. (Or mulitply 0.5 x2 and add to 3 cm.)
3 + 0.5 + 0.5 = 4 cm. (Or 0.5 x 2= 1.0 + 3 = 4 cm) You would then code the 4 cm to the proper location.

If you did it by the way you explained you would get an entirely different answer. If you actually took the narrowest diameter (2.5 cm) and multiplied it by the margin (0.5 cm) and added that to the largest diameter (3 cm) you would get: 2.5 x 0.5 = 1.25 + 3= 4.25 Doing it that way could end up with an incorrect code.

Just remember, that if the document gives you a such-n-such size lesion, the only number in it that matters to finding the correct code is going to be the largest side of the lesion and the margin.

If it is a 2 cm x 3.2 cm lesion with 0.3 cm margins, the only numbers you are going to work with are the 3.2 and adding 0.3 to it twice.
If it is 2 cm x 2 cm with 0.5 cm margins, you are only going to take 2 and add 0.5 to it twice.

Hope that helps.

Answer Thread:
Carolyn Heath

I went on AAPC website and did my research. I read just about every article I could find. That's where I found the article. I would never get this right because it is not calculated in the correct way and now I am getting frustrated. Everything I did on this particular problem is wrong and I am getting criticized for it. If this is on a test, I would get it wrong because I can't calculate this correctly. Back to more research to understand how to do it correctly.

Luna

​

I went on AAPC website and did my research. I read just about every article I could find. That's where I found the article. I would never get this right because it is not calculated in the correct way and now I am getting frustrated. Everything I did on this particular problem is wrong. If this is on a test, I would get it wrong because I can't calculate this correctly.

A mouse friend of mine is always reminding everyone:
Never say never, my friend... Keep up your courage, don't ever despair
Take heart and then count to ten
Hope for the best
Work for the rest and never say never again!

You will get this! A few more winks might help.

And then come back to it. And just know, all you do is take the largest diameter and add the margin twice.
Largest diameter, add the margin twice.
Largest diameter, add the margin twice.

Carolyn Heath​

If I haven't gotten this by now, I never will. Math is not my thing and I will never be able to calculate this correctly. I'll just keep researching until I find the answer that I am looking for.

Luna
Carolyn, I hate to see you despair like that.

I've seen your math above and can say: "You are too good at math!" The numbers are just "plugged into the wrong places", otherwise, your math is perfect.

I drew up some pictures that might help you know where to "plug" your numbers in at. Then all you have to do is add them together. You'll be saying "easy peasy" about excised diameters in no time!!!

The first image is using the B example from CPT pg. 66. (Pg 92 of 2024 CPT edition)
The second image is using the same formula with the dimensions given in the original question of this thread.

Attachments​

• 
  D forumexample.JPG
  965.7 KBViews: 3

Carolyn Heath
I can't open the images to get a closer look.

Luna
Not sure why. When I am signed in and click on the images they open up on a new tab. But not signed in, then they don't open.
So, if you are signed in, I'm not sure why it would not work for you.
Very sorry.

Luna
I just tried again. When I am signed in, then the first image open up in the reply, with the second image in a small window below it. When I click on the small picture, it opens up a picture slide, where you can advance from image to the other....When I'm not signed in, then both images are small and I can't open them. Maybe you were not signed in??? Otherwise, I don't know why it's not working.

Lori Woods
Carolyn your only mistake is saying you are multiplying by 2 cm instead of just by 2 (margins)(2x.03=.06) Luna is saying if you said a 4cm lesion instead of 2 which works in this case either way because if you multiplied that 4cm by an .03 margin you would get 1.2 which would be incorrect it is still an .06 margin.

Ruth Sheets

If the surgeon documents a malignant lesion is 2 CM X 3.2 CM with 3 MM Margins excised from the left shin with a complex repair. How do we figure out the size for the multi-deminsions plus the margins?
Thanks, Janice

We have a malignant lesion on the leg 2 CM x 3.2 CM requiring a complex repair. Guidelines under Excision - Malignant on pg 68(Pg 91 CPT 2024), 3rd paragraph of CPT 2013 Professional Edition states for excision of malignant lesions requiring more than simple closure...report 11600-11646 in addition ... appropriate complex closure (13100 - 13153).

Luna is correct. 3.2 CM is the longest dimension of the lesion, add in the .3 CM times 2 for the margins. So you look for codes in the above ranges for an excised diameter of 3.8 CM.

11604 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 3.1 to 4.0 cm.
13121 Repair, complex, scalp, arms, and/or legs: 2.6 cm to 7.5 cm.

Answer: 11604, 13121

Just a side bar... Math lesson: We are looking for the length (one dimension) so we add the pertinent numbers, longest length plus the margins on each side of that length, and the answer is in CM, a one dimensional unit. Now, if we needed the area (two dimensions) - say, for a graft - we would multiply the "width with margins" and the "length with margins" and come up with CM squared (a two dimensional unit). So pay attention to the units... are they looking for CM or sq CM? -- the code descriptions are really specific whether it is CM or sq CM. (For example, notice codes 14000 - 14061 for adjacent tissue transfer which are sq CM. ) The type of unit gives you a big hint as to whether you need to add or multiply the pertinent numbers. I love math... it makes so much sense! and I had some awesome teachers, which I'm sure helped me understand its logic.

Laureen
I just came accross this thread and had to chime in.

Diameter is just the larger number of the two i.e. 2 x 3cm lesion would be a 3 cm lesion, a 2 x 4 lesion would be a 4 cm diameter lesion, a 1 x 4 cm lesion would be a 4cm diameter lesion. You do not multiply or else you are doing square cm and you don't want that here.

THEN you add the margins to that number twice because diamter is drawing a line from one side to the other of a shape (and taking largest length) so with margins they are on both sides of a roundish lesion right?

I hope that helps for those who come along later and read this thread

Alicia Scott
That is why she is so good at CPT

 

[RinshidaK_89540]

Answer Thread:
Carolyn Heath

I went on AAPC website and did my research. I read just about every article I could find. That's where I found the article. I would never get this right because it is not calculated in the correct way and now I am getting frustrated. Everything I did on this particular problem is wrong and I am getting criticized for it. If this is on a test, I would get it wrong because I can't calculate this correctly. Back to more research to understand how to do it correctly.

Luna

​

A mouse friend of mine is always reminding everyone:
Never say never, my friend... Keep up your courage, don't ever despair
Take heart and then count to ten
Hope for the best
Work for the rest and never say never again!

You will get this! A few more winks might help.

And then come back to it. And just know, all you do is take the largest diameter and add the margin twice.
Largest diameter, add the margin twice.
Largest diameter, add the margin twice.

Carolyn Heath​

If I haven't gotten this by now, I never will. Math is not my thing and I will never be able to calculate this correctly. I'll just keep researching until I find the answer that I am looking for.

Luna
Carolyn, I hate to see you despair like that.

I've seen your math above and can say: "You are too good at math!" The numbers are just "plugged into the wrong places", otherwise, your math is perfect.

I drew up some pictures that might help you know where to "plug" your numbers in at. Then all you have to do is add them together. You'll be saying "easy peasy" about excised diameters in no time!!!

The first image is using the B example from CPT pg. 66. (Pg 92 of 2024 CPT edition)
The second image is using the same formula with the dimensions given in the original question of this thread.

Attachments​

• 
  D forumexample.JPG
  965.7 KBViews: 3

Carolyn Heath
I can't open the images to get a closer look.

Luna
Not sure why. When I am signed in and click on the images they open up on a new tab. But not signed in, then they don't open.
So, if you are signed in, I'm not sure why it would not work for you.
Very sorry.

Luna
I just tried again. When I am signed in, then the first image open up in the reply, with the second image in a small window below it. When I click on the small picture, it opens up a picture slide, where you can advance from image to the other....When I'm not signed in, then both images are small and I can't open them. Maybe you were not signed in??? Otherwise, I don't know why it's not working.

Lori Woods
Carolyn your only mistake is saying you are multiplying by 2 cm instead of just by 2 (margins)(2x.03=.06) Luna is saying if you said a 4cm lesion instead of 2 which works in this case either way because if you multiplied that 4cm by an .03 margin you would get 1.2 which would be incorrect it is still an .06 margin.

Ruth Sheets


We have a malignant lesion on the leg 2 CM x 3.2 CM requiring a complex repair. Guidelines under Excision - Malignant on pg 68(Pg 91 CPT 2024), 3rd paragraph of CPT 2013 Professional Edition states for excision of malignant lesions requiring more than simple closure...report 11600-11646 in addition ... appropriate complex closure (13100 - 13153).

Luna is correct. 3.2 CM is the longest dimension of the lesion, add in the .3 CM times 2 for the margins. So you look for codes in the above ranges for an excised diameter of 3.8 CM.

11604 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 3.1 to 4.0 cm.
13121 Repair, complex, scalp, arms, and/or legs: 2.6 cm to 7.5 cm.

Answer: 11604, 13121

Just a side bar... Math lesson: We are looking for the length (one dimension) so we add the pertinent numbers, longest length plus the margins on each side of that length, and the answer is in CM, a one dimensional unit. Now, if we needed the area (two dimensions) - say, for a graft - we would multiply the "width with margins" and the "length with margins" and come up with CM squared (a two dimensional unit). So pay attention to the units... are they looking for CM or sq CM? -- the code descriptions are really specific whether it is CM or sq CM. (For example, notice codes 14000 - 14061 for adjacent tissue transfer which are sq CM. ) The type of unit gives you a big hint as to whether you need to add or multiply the pertinent numbers. I love math... it makes so much sense! and I had some awesome teachers, which I'm sure helped me understand its logic.

Laureen
I just came accross this thread and had to chime in.

Diameter is just the larger number of the two i.e. 2 x 3cm lesion would be a 3 cm lesion, a 2 x 4 lesion would be a 4 cm diameter lesion, a 1 x 4 cm lesion would be a 4cm diameter lesion. You do not multiply or else you are doing square cm and you don't want that here.

THEN you add the margins to that number twice because diamter is drawing a line from one side to the other of a shape (and taking largest length) so with margins they are on both sides of a roundish lesion right?

I hope that helps for those who come along later and read this thread

Alicia Scott
That is why she is so good at CPT

Answer Thread:
Carolyn Heath
I still don't understand how to code lesions, but I will figure it out sooner or later.

Debbie Cunningham
I know this is 5 months later, however, I'm thinking someone isn't defining the word diameter correctly. This is not a perimeter we're discussing. Diameter is a straight line through the center of the lesion (length or width). In this case we want the length. A perimeter is the outside measurement of the lesion (which we don't want)

Lori Woods
Actually we are coding the width of the margins not just the diameter. These articles are helpful.

http://www.surgistrategies.com/articles/2012/03/3-rules-to-correct-lesion-excision-coding.aspx

http://news.aapc.com/index.php/2012/09/skin-lesion-excision-documentation-quick-tips/

http://campus.ahima.org/audio/2009/RB043009.pdf
(https://www.cco.community/threads/integumentary-surgery-2023-cpt-bhat-tm-annotation-guide-pdf.7815/)

Carolyn Heath
Here are the following links to YouTube on Integumentary Coding:

2013 CPT Skin --


2013 Advanced Integumentary --

(

Lori Woods
Thanks Carolyn I was looking for a particular video, but couldn't find it. This question is still haunting us LOL.

Carolyn Heath
You are most welcome, Lori! I remember seeing the video when I was researching something and liked how she went through the CPT book.

This is going to be fun to code when I start learning about integumentary system all over again when I go back to school in March.