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CODING & DOCUMENTATION
Comparing excision codes Q I submitted 21930 for the office removal of a 3-cm subcutaneous lipoma from a patient's lower left back, but our coders think 11403 is more accurate. What's the difference between 11403 and 21930?
A According to CPT, there are actually a number of differences between 11403 and 21930. Code 11403 is for "excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm," and it appears in the "surgery/integumentary system" section of the CPT manual. It is for full-thickness (through the dermis) removal of benign lesions of the skin or subcutaneous tissues (e.g., cicatricial, fibrous, inflammatory, congenital and cystic lesions), including local anesthesia and simple (nonlayered) closure. Code 21930 is for "excision, tumor, soft tissue of back or flank," and it appears in the "surgery/musculoskeletal system" of the manual. In the Medicare Fee Schedule database, 11403 has a 10-day global period and 21930 has a 90-day global period, suggesting that 21930 is a more extensive procedure.
There is nothing in the descriptor of 21930 that would obviously preclude its use in your situation. A lipoma is a fatty tumor, and the physician did excise it from the soft tissue of the back. The only indicator that this code may not be appropriate is the 90-day global period that Medicare attaches...