Skin cancer treatment uses multiple coding pathways depending on method: excision (CPT 11600-11646, varies by size), destruction (17260-17286 for cryotherapy, laser, electrocoagulation), or Mohs micrographic surgery (17311-17315). Excision requires pathology billing separately (88305, 88309). Size-based excision codes include the primary lesion plus removal margins. Wide local excision codes are the same as standard excision—size and location determine the code, not depth of excision. Destruction does not remove tissue, so pathology is not billable. Melanoma uses ICD-10 C43.x; non-melanoma (basal cell, squamous cell) uses C44.x. Prior authorization is not required for excision on the face or extremities, but may be required for Mohs on non-facial sites.
Excision is coded by pre-excision lesion size (including margins). Size ranges: 11600-11602 (0.5 cm or less), 11603-11605 (1.1-2 cm), 11606-11608 (2.1-3 cm), 11609-11611 (3.1-4 cm), and so on. Document the lesion location (face, scalp, trunk, extremities) as this determines which code set applies. Destruction codes (17260-17286) apply when lesions are removed by laser, liquid nitrogen, or electrosurgery without excision. Bill the appropriate code set once per lesion per location. If multiple lesions are excised, each is coded separately. Pathology (88305 for intermediate, 88309 for complex) is billed on a separate line.
Skin cancer excision on the face does not require prior auth. Excision on trunk, extremities, or non-cosmetically sensitive areas also does not require prior auth. Mohs on non-facial sites may require prior auth for medical necessity justification. Destruction without excision (benign lesions) does not require prior auth. Some payers limit the number of destruction procedures per patient per year (e.g., 4-6 annually). Excision and destruction are not bundled; both can be billed on the same day for different lesions. Verify coverage limits with the patient's plan before scheduling.
Excision and pathology are not bundled. Bill both on the same claim without modifiers. If closure (sutures, flap) is performed after excision, standard closure codes are included in the excision code. Do not bill closure separately. If skin graft is needed (rare for skin cancer), bill the graft code (15040, etc.) in addition to excision. Do not use modifier 51 (multiple procedure reduction) when excision and pathology are billed together. Use standard anatomical modifiers (50 for bilateral) if applicable. When multiple lesions are excised, each is coded individually without modifiers.
Document the lesion's location, pre-excision size (length and width in centimeters, including planned margins), clinical diagnosis (suspected melanoma, basal cell carcinoma, squamous cell carcinoma), and clinical indication (itching, bleeding, rapid growth, change in appearance). Record margins in the operative note (margins in mm from lesion edge). After excision, document the orientation of the specimen for pathology and any special instructions. Include pathology results: histology, margins (clear vs. involved), depth (Clark level for melanoma, if applicable), and any high-risk features (perineural invasion, mitotic rate). Update the treatment plan based on pathology findings.
No. The first excision is billed once based on the pre-excision size. If re-excision is needed for positive margins, it is a separate procedure billed on a different date with its own size coding. Document the reason for re-excision (positive margins from prior pathology) in the operative note.
Estimate the size as accurately as possible by visual inspection and palpation. Measure with a ruler or calipers. Document your estimated size and margins in the operative note. Payers accept size estimates for coding purposes. If the actual specimen is significantly smaller after excision, use the pre-excision size for coding.
No. Never use destruction for suspected skin cancer. Always excise suspicious lesions to allow pathologic diagnosis. Destruction is only for benign lesions (seborrheic keratosis, skin tags, common warts). Using destruction on undiagnosed lesions prevents pathologic confirmation and may delay melanoma diagnosis—a clinical and legal liability.
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