tci ED Coding & Reimbursement Alert - 2004 Issue 7

Reader Question: Check Place and State for Tumor Code

Question: The physician excised a 2.7-centimeter tumor on a 34-year-old male outpatient. How should I code this scenario, and are there any diagnosis codes that payers tend to look for when reviewing these claims? Michigan SubscriberAnswer: It depends on the state of the tumor and in what anatomic site the tumor is located. For a benign tumor, you would report one of the following codes, depending on the tumor's location: 11403 - Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter 2.1 to 3.0 cm 11423 - Excision...

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