The guidelines with excision–benign lesion provide directions to code additionally for intermediate and complex closures.

Code 11056 includes two to four lesions

For narrowing down to the correct procedure code for the Mohs micrographic surgery, you should find out where on the body the tumor was removed. For this scenario, it is the neck; eliminating multiple choice codes B and C, which involve the trunk, arms or legs. The tissue block removals were performed in two stages,coding 17311 and 17312. Code 17315 is not coded for this scenario, since the physician would have to remove more than five tissue blocks in any stage. There were only four tissue blocks removed in the first stage and two tissue blocks removed in the second stage, both falling short of six or more tissue blocks removed in either stage.

The two face lacerations were closed with steri-strips (adhesive strips). According to CPT® guidelines when wound closure uses adhesive strips as the only repair material it should be coded using the appropriate E/M service. Code 12011 is inappropriate to report for this scenario, eliminating multiple choices A and B.The repairs for the wounds on the arm and leg are intermediate closures.According to CPT® guidelines single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. This eliminates multiple choice C. To report multiple wounds that are repaired in the same classification and from the anatomic sites that are grouped together into the same code descriptor, add together the length of the wounds. When more than one classification of wounds is repaired, append modifier 59 to the least complicated repair(s). (OR)Laceration of arm was 5 cm and leg was also 5cm = 10 cm, method of closure is single layered closure (i.e. Intermediate closure) therefore assign code 12034 is the only option correct in this scenario.

You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they deal with benign lesions. Now you need to find out where the lesion is located and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm = 3.3 cm, leading you to code 11644. CPT® guidelines state: For excision of malignant lesion(s) requiring intermediate or complex closures should be reported separately. For this scenario the wound was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052.