Excision is defined as full-thickness (through the dermis) removal of a benign lesion of skin, including margins, and includes simple (non-layered) closure when performed. Therefore, you can only bill for the closure if intermediate or complex repair is required.

 

I. Medical Necessity

Aetna considers the following as medically necessary:

Removal of acquired or small (less than 1.5 cm) congenital nevi (moles), cutaneous and subcutaneous neurofibromas, dermatofibromas, dermatosis papulosa nigra, acrochordon (skin tags), pilomatrixomata (slow-growing hard mass underneath the skin that arises from hair follicle matrix cells), sebaceous cysts (pilar and epidermoid cysts), seborrheic keratoses (also known as basal cell papillomas, senile warts or brown warts), or other benign skin lesions, or needle hyfrecation for sebaceous hyperplasia, medically necessary if any of the following criteria is met:

A. Biopsy suggests or is indicative of pre-malignancy (e.g., dysplasia) or malignancy; or

B. Due to its anatomic location, the lesion has been subject to recurrent trauma/irritation (eg, bra line, waist band, etc.); or

C. Lesion appears to be pre-malignant (e.g., actinic keratoses (see CPB 0567 - Actinic Keratoses Treatment), Bowen's disease, dysplastic lesions, dysplastic nevus syndrome, large congenital melanocytic nevi, lentigo maligna, or leukoplakia) or malignantFootnote1* (due to coloration, change in appearance or size, etc. (see note below) especially in a person with personal or family history of melanoma); or

D. Skin lesions are causing symptoms (e.g., bleeding, burning, intense itching, or irritation); or

E. The lesion has evidence of inflammation (e.g., edema, erythema, or purulence); or

F. The lesion is infectious (e.g., warts (verruca vulgaris)); or

G. The lesion restricts vision or obstructs a body orifice.
Footnote1*Note: Clinical suspicion of malignancy, is indicated by any of the following:

H. Asymmetry - one half of the mole or lesion does not match the other half;

I. Border - the edges of a mole or lesion are irregular, ragged, blurred;

J. Color - the color is not the same all over and may include shades of brown or black or sometimes have patches of pink, red, white or blue;

K. Diameter - the mole or lesion is larger than six millimeters across (about ¼ inch or the size of a pencil eraser); or

L. Evolving - the mole is changing in size (enlarging), shape or color.

 

II. Cosmetic

In the absence of any of the above indications in section I, Aetna considers the following cosmetic:

Removal of dermatofibromas, dermatosis papulosa nigra, pilomatrixoma, poikiloderma of Civatte (sun aging), sebaceous cysts, seborrheic keratoses, small nevi (moles), or other benign skin lesions, or needle hyfrecation for sebaceous hyperplasia.