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.

Reason for procedure

A fictional adult has a documented benign lesion on the left upper arm that repeatedly catches on clothing and bleeds. The clinician documents the symptoms and examination findings and explains the planned removal. This is not a record containing only the unsupported phrase “irritated lesion.”

Pre-excision measurement

Before removal, the clinician records a greatest lesion diameter of 1.4 cm. The narrowest necessary margin is 0.2 cm on each side. The operative note documents full-thickness excision and identifies the left-arm specimen. These measurements are supplied directly; they are not inferred from a photograph.

Closure and pathology

The clinician performs ordinary simple closure, with a resulting repair length of 3.1 cm. The final diagnostic record remains benign. No separate lesion biopsy or advanced repair is documented. The wound is dressed and postoperative instructions are given.

Coding request

Abstract the excision measurement, identify included work and find the applicable location and size interval in the authorized book. The worksheet concerns professional reporting under the cited WPS policy and NCCI, not a promise that any submitted claim will be paid.

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