Mountain State Medical Policy Bulletin
Section: Surgery
Number: S-36
Topic: Removal of Multiple Skin Lesions
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

The removal of lesions can be identified by the codes appropriate to the type of removal as well as the type and number of lesions, e.g., 11400-11446 for excision of benign lesions, 11600-11646 for excision of malignant lesions and 17000-17004 for chemosurgical, cryosurgical, or electrosurgical destruction of lesions, destruction by laser, or surgical curettement.

Multiple procedures up to and including five at one session are priced in accordance with the multiple surgery guidelines on Medical Policy Bulletin S-100.

Removal of lesions in excess of five at one session are priced at fifty percent of the allowance, providing this amount does not exceed the billed charge.

Excision of lesions includes simple closure of wounds.  More complex closures can be paid separately.

Procedure Codes

110551105611057112001120111300
113011130211303113051130611307
113081131011311113121131311400
114011140211403114041140611420
114211142211423114241142611440
114411144211443114441144611600
116011160211603116041160611620
116211162211623116241162611640
116411164211643116441164617000
170031700417110171111726017261
172621726317264172661727017271
172721727317274172761728017281
17282172831728417286  

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

12/2004, Closures following surgery considered part of the global/surgery allowance

References

View Previous Versions

No Previous Versions

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.