One removal and a separate lesion sample

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

Chart gym · Original fictional record

Service date: 2026-09-09 · Office integumentary professional service

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. Lesion A is a recurrent tender nodule on the left upper arm. Lesion B is a separate changing pink plaque on the right shoulder. The clinician marks both sites and plans removal of A and diagnostic punch sampling of B.

Signed procedure: lesion A

Before removal, lesion A measures 1.0 cm at its greatest diameter with a 0.1 cm necessary margin on each side. The clinician takes a small tissue biopsy and then completes ordinary full-thickness excision of the same lesion during this encounter. Simple skin closure follows. Pathology later identifies a benign epidermal cyst. No Mohs surgery is performed.

Signed procedure: lesion B

A 4 mm punch obtains a diagnostic sample from the distinct right-shoulder plaque. The remaining plaque is not removed. The biopsy opening is closed with one simple suture. The specimen is labeled B, right shoulder; its final diagnosis is pending. Wound-care instructions cover both sites.

Coding worksheet

The proposed procedure list contains the left-arm excision, a biopsy of A and a biopsy of B. Trace each line to the actual lesion and technique. This exercise asks which biopsy can proceed to separate-reporting review; it does not establish a particular edit modifier or a malignant diagnosis for B.

Your coding worksheet

Map each proposed procedure to lesion A or B.
Calculate the pre-excision diameter for A and identify its included biopsy.
Identify the documented biopsy technique for B.
Use the authorized entries and applicable edit instructions to finish the procedure review.

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

Lesion A is the left-arm lesion; its pre-excision diameter is 1.0 + 0.1 + 0.1 = 1.2 cm. The small biopsy of A is included in its ordinary same-encounter excision.
Lesion B is a distinct right-shoulder lesion sampled by a 4 mm punch. Its different documented site supports separate biopsy review.
Separate specimen labels alone would not establish different lesions; the clinical and operative records do so here. Do not infer malignancy from the pending sample.
Use the full excision and punch-biopsy entries and their inclusion instructions. Check the actual code pair and payer modifier rules before completing the claim.

Reference sections: NCCI III E.1–2; WPS LCD Coverage Guidance: excised diameter

Practice the linked chart questions