Medicare Benefits Schedule - Item 31365

Malignant skin lesion (other than a malignant skin lesion covered by item 31369, 31370, 31371, 31372, 31373, 31377, 31378 or 31379), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b)     the necessary excision diameter is less than 15 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201

Multiple Operation Rule

(Anaes.)

Fee: $180.30 Benefit: 75% = $135.25 85% = $153.30

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

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The excision of warts and seborrheic keratoses attracts benefits on an attendance basis with the exceptions outlined in TN.8.9 of the explanatory notes to this category. Excision of pre-malignant lesions including solar keratoses where clinically indicated are covered by items 31357, 31360, 31362, 31364, 31366, 31368 and 31370. 

The excision of pigmented lesions which are clinically suspicious for melanoma attracts benefits under items 31377, 31378, 31379, 31380, 31381, 31382 or 31383. 

Excision of malignant tumours are covered by items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371 to 31376, 31386, 31387 and 31388.

Items 31386, 31387 and 31388 should be used for very large, fungating skin cancers.

Items 31357, 31360, 31362, 31364, 31366, 31368, 31370, 31377, 31378, 31379, 31380, 31381, 31382 and 31383 require that the specimen be sent for histological examination. Items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371-31376, 31386, 31387 and 31388 also require that a specimen has been sent for histological confirmation of malignancy, and any subsequent specimens are sent for histological examination. Confirmation of malignancy must be received before itemisation of accounts for Medicare benefits purposes, except in the case of items 31377, 31378, 31379, 31380, 31381, 31382 or 31383.

An incomplete surgical excision of a malignant skin lesion with curative intent should be billed as a malignant skin lesion excision item even when further surgery is needed.

Where histological results are available at the time of issuing accounts, the histological diagnosis will decide the appropriate itemisation for excised lesions. If the histological report shows the lesion to be benign, items 31357, 31360, 31362, 31364, 31366, 31368 or 31370 should be used. 

Practitioners should retain copies of histological reports.

Related Items: 31356 31357 31358 31359 31360 31361 31362 31363 31364 31365 31366 31367 31368 31369 31370 31371 31372 31373 31374 31375 31376 31386 31387 31388

The necessary excision diameter (or defect size) refers to the lesion size plus a clinically appropriate margin of healthy tissue required with the intent of complete surgical excision. Measurements should be taken prior to excision. Margin size should be determined in line with current NHMRC guidelines.  

For the purpose of items 31356 to 31388, the defect size is calculated by the average of the width and the length of the skin lesion and an appropriate margin. The necessary excision diameter is calculated as shown in the Factsheet at this link: Determining lesion size for MBS selection

Practitioners must retain copies of histological reports and any other supporting evidence (patient notes, photographs etc). Photographs should include scale.

An episode of care includes both the excision and closure for the same defect, even when excision and closure occur at separate attendances.

The initial excision of a suspected melanoma may be claimed using item 31377, 31378, 31379, 31380, 31381, 31382 or 31383, depending on the location of the malignancy and the size of the excision diameter. Wide excision of the primary tumour bed following histological confirmation of melanoma, appendageal carcinoma, malignant connective tissue or merkel cell carcinoma of the skin may be claimed using item 31371, 31372, 31373, 31374, 31375 or 31376, depending on the location of the malignancy and the size of the excision diameter.

For items 31356 to 31370, 31386, 31387 and 31388, a malignant skin lesion is defined as a basal cell carcinoma; a squamous cell carcinoma (including keratoacanthoma); a cutaneous deposit of lymphoma; or a cutaneous metastasis from an internal malignancy.

Related Items: 31356 31357 31358 31359 31360 31361 31362 31363 31364 31365 31366 31367 31368 31369 31370 31371 31372 31373 31374 31375 31376 31377 31378 31379 31380 31381 31382 31383 31386 31387 31388