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a patient had an excision of a malignant lesion of the perianal area. One coder suggested 11623 and the other would like to use an unlisted code such as 46999. This is surgical excision and mass which is an abnormality here can be considered as lesion here. wide excision of squamous cell carcinoma of anus repair of fistual ano after consent was obtained patient was brought to or and placed in supine position. A wide local excision (wle) is a surgical procedure to remove a small area of diseased or problematic tissue with a margin of normal tissue. This procedure is commonly performed on the breast and to skin lesions, but can be used on any area of the body. The tissue removed is examined under a microscope to confirm the type of lesion and to grade malignant tumours. Anal fistulas very rarely heal by themselves, so surgical excision is the only way they can be treated. What happens during an excision of an anal lesion? The surgical excision of haemorrhoids (haemorrhoidectomy) involves the gentle opening of the anus so the haemorrhoids can be removed. Skin excision coding may seem complex at first, but you can easily master it in four steps 1 check the pathology report. Skin excision codes are first classified based on information extracted from the pathology report on whether the lesion is benign (non-cancerous) or malignant (cancerous). Under general anesthesia, the patient was placed in the lithotomy position and wide local excision was performed including some muscle fibers of the internal anal sphincter inorder to achieve clear margin. On the cut surface, the lesion was greyish white in color and measured 2 1.