A lesion diameter and a longer closure

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · WPS Medicare office skin procedure

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Office examination

Synthetic record, September 9, 2026. An adult reports that a raised lesion on the left upper arm repeatedly catches on a shirt sleeve and bleeds. Examination shows a brown papule with a small surface crust and no surrounding erythema. The clinician recommends full-thickness removal because recurrent trauma and bleeding persist.

Signed procedure note

Before excision, the clinician measures the greatest lesion diameter as 1.4 cm and marks a narrowest necessary margin of 0.2 cm on each side. After local anesthesia, the clinician excises the lesion through the full thickness of the dermis and sends the left-upper-arm specimen for pathology.

Closure and follow-up

The wound receives a simple single-layer skin closure measuring 3.1 cm. No layered repair, flap or separate biopsy is performed. Hemostasis is achieved, a dressing is applied and wound-care instructions are given. The later pathology report identifies a benign melanocytic nevus.

Coding worksheet

For this WPS Medicare professional-service exercise, determine the excision measurement and simple-closure relationship. Use the benign diagnosis, upper-arm site and current authorized entry for the procedure lookup. Medical necessity and payment require their own coverage review.

Your coding worksheet

Calculate the excised diameter in centimeters.
Explain why the repair length does not replace it.
Identify the simple-closure relationship.
Locate the current benign-excision family and applicable site/size interval.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

1.4+0.2+0.2 = 1.8 cm before excision.
The 3.1 cm length belongs to the closure and measures a different feature.
Ordinary simple closure is included under the cited NCCI removal rule.
Use the documented benign diagnosis, left-upper-arm site and 1.8 cm excision measurement to complete the licensed-entry lookup; retain the symptom documentation for the separate coverage review.

Reference sections: LCD Coverage Guidance; NCCI III E.6

Practice the linked chart questions