Can D7413 be used for benign lesions?

No, D7413 specifically applies to malignant lesions. Use appropriate codes for benign excisions.

Is prior authorization required for D7413?

Prior authorization may be required depending on the patient's insurance plan. Verify with the insurer beforehand.

What documentation is needed for insurance claims?

Include clinical notes, pathology reports, operative reports, and patient consent forms with the claim.

Are there any modifiers commonly used with D7413?

Modifiers such as -22 for increased procedural services may be applicable if the procedure is more complex than usual.

D7413

Excision Malignant Lesion - CDT Code Guide

Oral & Maxillofacial Surgery/Excision of Soft Tissue Lesions

Overview

CDT code D7413 pertains to the excision of a malignant lesion up to 1.25 cm in size. This procedure is typically performed by oral and maxillofacial surgeons to remove cancerous tissue from the oral cavity. The excision involves carefully cutting out the lesion along with a margin of healthy tissue to ensure complete removal and minimize the risk of recurrence. This code is crucial for documenting surgical interventions in cases of oral cancer, where early detection and treatment are vital for patient outcomes. It is commonly used in scenarios where a biopsy has confirmed malignancy, and a surgical approach is necessary to prevent further spread.

When to Use This Code

Confirmed diagnosis of a malignant lesion in the oral cavity measuring up to 1.25 cm.
Following a biopsy that indicates malignancy and requires surgical excision.
When a patient presents with a suspicious lesion that has been clinically assessed as potentially malignant.
As part of a treatment plan for oral cancer involving surgical intervention.
In cases where imaging studies suggest the presence of a malignant lesion requiring removal.

Documentation Requirements

Detailed clinical notes describing the lesion and the need for excision.
Pathology report confirming malignancy prior to the procedure.
Operative report detailing the excision process and margins.
Post-operative care instructions and follow-up plan.
Patient consent forms acknowledging understanding of the procedure and risks.

Billing Considerations

When billing for D7413, ensure that the diagnosis code supports the medical necessity of the procedure. Be aware of any frequency limitations set by insurance providers, as multiple excisions may require additional documentation. Common modifiers such as -22 for increased procedural services may apply if the lesion is particularly complex. Verify coverage with the patient's insurance, as policies on oral cancer treatments can vary significantly.

Related CDT Codes

D7410 D7411 D7412 D7415 D7465

Frequently Asked Questions

Code D7413 is used for excising malignant lesions up to 1.25 cm in size.

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