Summary & Overview
CPT 27613: Excision of Skin Lesion, Leg or Ankle
CPT code 27613 denotes the surgical excision of a skin lesion on the leg or ankle with submission of the tissue for pathologic examination. This code is used when clinicians remove a lesion to obtain a tissue diagnosis, a common step in the management of suspicious cutaneous lesions. Nationally, accurate coding for lesion excision affects clinical documentation, pathology utilization, and surgical services billing across ambulatory and outpatient settings.
This analysis covers payer considerations for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for lesion excision, typical sites of service, and the elements that drive coding and claim adjudication. The publication outlines benchmarks and common billing scenarios, highlights policy and documentation issues that influence claim acceptance, and summarizes clinical indications that commonly accompany use of this code.
Intended for clinicians, billing specialists, and policy analysts, the content clarifies how CPT code 27613 fits into surgical dermatology and outpatient procedural workflows. Data not available in the input is noted where applicable, and readers will gain a concise reference for coding, clinical context, and areas where documentation often determines reimbursement outcomes.
Billing Code Overview
CPT code 27613 describes the excision of a skin lesion located on the leg or ankle with submission of the specimen for pathological evaluation. The procedure is performed to establish a definitive diagnosis of the skin lesion through tissue removal and histopathologic analysis.
-
Service type: Surgical excision for diagnostic purposes
-
Typical site of service: Ambulatory surgery center, hospital outpatient department, or office-based procedure room
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an outpatient dermatology clinic with a solitary, irregular pigmented lesion on the lateral ankle noted to have changed in size over several months. The provider performs a planned excision of the skin lesion under local anesthesia in the office procedure room. The specimen is submitted for pathological evaluation to establish a definitive diagnosis (benign nevus, dysplastic nevus, cutaneous squamous cell carcinoma, basal cell carcinoma, or melanoma). Typical workflow: pre-procedure evaluation and informed consent, local anesthetic administration, elliptical or wedge excision of the lesion with appropriate margins, hemostasis, wound closure with sutures, specimen labeling and submission to pathology with pathology requisition, post-procedure wound care instructions, and scheduling follow-up for suture removal and pathology result review. The typical site of service is an outpatient dermatology or ambulatory surgery clinic. Service type is an excisional biopsy of skin on the leg/ankle for diagnostic pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the provider's professional component separate from technical services (rare for simple excisions but applicable if reporting separately for pathology interpretation). |
50 |