Highmark West Virginia Medical Policy Bulletin
Section: Surgery
Number: S-36
Topic: Removal of Multiple Skin Lesions
Effective Date: January 1, 2008
Issued Date: January 17, 2011
Date Last Reviewed: 01/2006

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.

When multiple lesions are removed during the same operative session, payment will be made at 100% of the allowance for the highest paying or primary procedure and 50% of the allowance for each secondary procedure.

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

The excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is not separately reportable with the adjacent tissue transfer (14000-14300).  Report only the adjacent tissue transfer (14000-14300).

Procedure Codes

110551105611057112001120111300
113011130211303113051130611307
113081131011311113121131311400
114011140211403114041140611420
114211142211423114241142611440
114411144211443114441144611600
116011160211603116041160611620
116211162211623116241162611640
116411164211643116441164614000
140011402014021140401404114060
140611430017000170031700417110
171111726017261172621726317264
172661727017271172721727317274
172761728017281172821728317284
17286     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

[Version 004 of S-36]
[Version 003 of S-36]
[Version 002 of S-36]
[Version 001 of S-36]

Table Attachment

Text Attachment

Procedure Code Attachments

Diagnosis Codes

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 Highmark West Virginia 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.

Highmark West Virginia retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark West Virginia. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.