Direct Answer
Dermatology billing is procedure-intensive with codes organized by technique, lesion size, and anatomic location. The four major dermatology procedure families are shave removal (11300-11313), excision (11400-11646), destruction (17000-17286), and Mohs micrographic surgery (17311-17315). Correct code selection requires knowing: (1) the technique used (shave vs. excision vs. destruction vs. Mohs), (2) the lesion size in centimeters measured at the greatest diameter including margins, and (3) the anatomic location. Closure is separately billable in addition to excision codes for intermediate and complex repairs. Each lesion is coded separately with the appropriate additional-lesion add-on codes.
Table of Contents
Shave Removal Codes 11300-11313
Shave removal codes are used when a superficial skin lesion is removed by a transverse incision or horizontal slicing technique without full-thickness dermal excision: Shave removal code families by location: Trunk, arms, or legs: 11300 — shaving of epidermal or dermal lesion; single lesion; trunk, arms or legs; lesion diameter 0.5 cm or less; 11301 — lesion diameter 0.6 to 1.0 cm; 11302 — 1.1 to 2.0 cm; 11303 — over 2.0 cm; Scalp, neck, hands, feet, genitalia: 11305 — 0.5 cm or less; 11306 — 0.6 to 1.0 cm; 11307 — 1.1 to 2.0 cm; 11308 — over 2.0 cm; Face, ears, eyelids, nose, lips, mucous membrane: 11310 — 0.5 cm or less; 11311 — 0.6 to 1.0 cm; 11312 — 1.1 to 2.0 cm; 11313 — over 2.0 cm; Key distinctions: shave removal vs. excision: shave removal removes the lesion at the level of the dermis — a full-thickness excision is not performed and the wound heals by secondary intention; if the pathology report shows the specimen has a true base (subcutaneous tissue), the procedure was an excision, not a shave, and the excision code should be used; size measurement: the lesion size is measured at the greatest diameter of the lesion being removed, not the wound size; multiple lesions: each lesion is coded separately using the appropriate code for its size and location; the first lesion is billed at full value; additional lesions in the same anatomic region may be subject to multiple procedure reductions.
Skin Lesion Excision 11400-11646
Excision codes are used when a full-thickness (through the dermis) removal of a skin lesion is performed, with the excised diameter including margins: Benign lesion excision (11400-11471): Trunk, arms, or legs: 11400 (excised diameter 0.5 cm or less), 11401 (0.6-1.0 cm), 11402 (1.1-2.0 cm), 11403 (2.1-3.0 cm), 11404 (3.1-4.0 cm), 11406 (over 4.0 cm); Scalp, neck, hands, feet, genitalia: 11420-11426; Face, ears, eyelids, nose, lips, mucous membrane: 11440-11446; Malignant lesion excision (11600-11646): Trunk, arms, or legs: 11600 (0.5 cm or less), 11601 (0.6-1.0 cm), 11602 (1.1-2.0 cm), 11603 (2.1-3.0 cm), 11604 (3.1-4.0 cm), 11606 (over 4.0 cm); Scalp, neck, hands, feet, genitalia: 11620-11626; Face, ears, eyelids, nose, lips, mucous membrane: 11640-11646; Excised diameter calculation: the excised diameter = the lesion's greatest clinical diameter plus the margins taken on all sides; example: a 0.8 cm lesion excised with 0.2 cm margins on each side = 0.8 + 0.2 + 0.2 = 1.2 cm excised diameter; bill 11401 (benign, trunk/arm/leg, 0.6-1.0 cm) would be incorrect — bill 11402 (1.1-2.0 cm); Wound closure and excision: simple closure is included in the excision codes; intermediate closure (layered closure): use 12031-12057 in addition to the excision code; complex repair: use 13100-13153 in addition to the excision code; skin graft or flap: use the appropriate graft/flap code in addition to the excision code.
Destruction Codes 17000-17286
Destruction codes cover the ablation of skin lesions by any method (cryotherapy, electrosurgery, laser, chemical): Premalignant lesion destruction (actinic keratoses): 17000 — destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratosis); first lesion; 17003 — second through 14 lesions, each (add-on to 17000); 17004 — 15 or more lesions; Benign lesion destruction: 17110 — destruction of flat warts, molluscum contagiosum, or milia; up to 14 lesions; 17111 — 15 or more lesions; 17260 — destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement); trunk, arms, or legs; lesion diameter 0.5 cm or less; 17261 — 0.6-1.0 cm; 17262 — 1.1-2.0 cm; 17263 — 2.1-3.0 cm; 17264 — 3.1-4.0 cm; 17266 — over 4.0 cm; Condylomata/warts: 17110/17111 for flat lesions; 17000-17004 for premalignant lesions; skin tags: 11200 — removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions; 11201 — each additional 10 lesions (add-on); Photodynamic therapy (PDT): 96567 — photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa; 96573 — photodynamic therapy by external application of light; each 250 sq cm; 96574 — debridement of premalignant hyperkeratotic lesion(s) to prepare for photodynamic therapy; Chemical peel: 15788 — chemical peel, facial; epidermal; 15789 — dermal; 15792 — chemical peel, nonfacial; epidermal; 15793 — dermal; chemical peels are typically cosmetic and not covered by insurance unless performed for specific medical indications.
Mohs Micrographic Surgery 17311-17315
Mohs micrographic surgery is a specialized technique for skin cancer removal where the surgeon serves dual roles as surgeon and pathologist: Mohs surgery codes: 17311 — Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s); head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks; 17312 — each additional stage after the first stage, up to 5 tissue blocks (add-on); 17313 — trunk, arms, or legs; first stage, up to 5 tissue blocks; 17314 — each additional stage after the first stage (add-on); 17315 — Mohs micrographic technique, each additional block after the first 5 tissue blocks, any stage (add-on); Mohs billing structure: the first stage is billed with either 17311 (head/neck/hands/feet/genitalia) or 17313 (trunk/arms/legs); each additional stage requires 17312 or 17314; each additional block beyond 5 in any stage requires 17315; example: Mohs surgery on the nose, 2 stages, 8 total tissue blocks: 17311 (stage 1, first 5 blocks) + 17312 (stage 2 add-on) + 17315 × 3 (3 additional blocks beyond the 5 in stage 2); Wound repair after Mohs: wound repair after Mohs surgery is separately billable; simple closure is typically included in E&M; intermediate or complex repair (12031-13153), skin graft (15100-15278), or local flap (14000-14350) is billed separately; Pathology during Mohs: the pathology is performed by the Mohs surgeon — no separate pathology code is billed for the intraoperative tissue examination; a separate pathologist cannot bill for the Mohs-stage tissue processing; Pre-authorization: Mohs surgery typically requires prior authorization for commercial payers; the PA request must document: histologic diagnosis, anatomic location, lesion size, and clinical indication for Mohs technique (recurrent, high-risk location, etc.).
Dermatology Denials and RCM
Dermatology billing denials concentrate around excision size documentation, cosmetic vs. medically necessary distinction, and Mohs stage coding: Common dermatology denial patterns: excised diameter not documented or documented incorrectly: the billed excision code must be supported by a documented excised diameter in the operative note; the excised diameter must include the margins added to the lesion; billing a code that doesn't match the documented size is an overcoding or undercoding issue; pathology measurement discrepancy: the pathology report may measure the specimen differently than the surgeon documented; if the path report shows a specimen smaller than what supports the billed code, the payer may recoup based on the pathology report; documentation should include both the clinical measurement at the time of excision and the orientation of the specimen; cosmetic denial: skin lesion removal that the payer classifies as cosmetic (sebaceous cysts, lipomas in cosmetically non-impaired locations, skin tags) may be denied as not medically necessary; documentation should support the clinical indication — symptomatic lipoma, infected sebaceous cyst, skin tags causing irritation or hygiene issues; Modifier 25 for E&M and procedure same day: when a dermatologist performs an E&M and a procedure (biopsy, destruction, excision) in the same visit, Modifier 25 is appended to the E&M to indicate that the E&M was a separately identifiable service above and beyond the decision to perform the procedure; the E&M must document a significant and separately identifiable evaluation — not just the decision to do the procedure; dermatology-specific RCM: separate E&M from procedural visits: dermatology practices that bill E&M + procedure on the same date without Modifier 25 (or with inadequate E&M documentation) are at high denial risk; train providers on the Modifier 25 documentation standard; lesion size documentation template: the operative note template should require the surgeon to document both the lesion clinical diameter and the excised diameter (with margins) as distinct measurements to support the correct code selection.
FAQ
What is the difference between shave removal, excision, and destruction for skin lesion coding — and how do you choose the right code?
The technique used to remove the lesion determines the correct code family. The clinical documentation must describe the technique clearly: Shave removal (11300-11313): technique: a sharp instrument is used to tangentially slice the lesion from the skin surface without penetrating into the deep dermis or subcutaneous tissue; the wound heals by secondary intention (no sutures); pathology specimen: a superficial disc of tissue without subcutaneous tissue; use when: removing superficial lesions — seborrheic keratoses, skin tags, superficial nevi, papillomas — that are at or near the skin surface and do not require full-thickness removal; do NOT use when the specimen includes fat or subcutaneous tissue (that's an excision); Excision (11400-11646): technique: a full-thickness removal through the dermis and into subcutaneous tissue, typically with an elliptical incision; the wound is closed (primarily or with repair); pathology specimen: specimen includes subcutaneous tissue; use when: removing lesions that require full-thickness removal — clinically concerning nevi, cysts, lipomas, basal cell and squamous cell carcinoma for margin-clear excision; the excised diameter includes the lesion plus the margin taken on each side; Destruction (17000-17286): technique: lesion is ablated in place — no specimen is sent to pathology; methods include cryotherapy (liquid nitrogen), electrodesiccation, curettage, laser ablation, chemical destruction; use when: treating benign or premalignant lesions where tissue preservation is not needed for pathologic diagnosis — actinic keratoses (17000-17004), warts (17110-17111), seborrheic keratoses that are clearly benign clinically; do NOT use destruction codes if a biopsy specimen is collected — that's a biopsy (11100-11101) or excision; The billing risk: using a destruction code when a specimen was sent to pathology is incorrect; using a shave code when the pathology report shows subcutaneous tissue in the specimen is incorrect; the technique must match the code family billed.
How are multiple skin lesions billed when treated in the same visit?
Multiple skin lesion billing follows specific rules depending on the procedure type: Multiple destruction (actinic keratoses): the most commonly encountered multiple-lesion scenario; 17000 is billed for the first lesion; 17003 is an add-on code billed for each additional lesion from the second through the fourteenth; 17004 replaces both 17000 and 17003 when 15 or more lesions are treated in one session; the note must document the number of lesions treated — if the note says "multiple AKs treated" without a count, the number of 17003 units cannot be supported; Multiple excisions: each lesion excision is billed with the appropriate excision code based on its individual size and location; NCCI does not bundle separate excision codes for separate lesions; however, multiple procedure reduction applies: the highest-RVU excision is paid at 100%; subsequent excisions are typically paid at 50% of the fee schedule; Multiple biopsies: 11100 — skin, subcutaneous tissue, and/or mucous membrane (including simple closure), when performed; single lesion; 11101 — each separate/additional lesion (add-on); 11101 is an add-on to 11100 for each additional lesion biopsied; Multiple shave removals: each lesion is coded separately with the appropriate shave removal code; multiple procedure reductions apply; Documentation requirements for multiple lesions: the procedure note must individually document each lesion treated, including: location (using anatomic descriptors or a body diagram); size (each individual lesion's size); method of treatment; for excisions: margins taken on each lesion; this documentation supports each separately billed code unit and protects against audit recoupment.
Dermatology Revenue Cycle Management That Captures Every Lesion and Procedure
Valiant Lifecare's dermatology billing specialists manage shave removal and excision size documentation accuracy, destruction code unit calculation for multiple AKs, Mohs surgery stage and block coding, complex wound repair billing in addition to excision, Modifier 25 compliance for same-day E&M and procedures, and the full spectrum of dermatology denial prevention.
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