Removal of Skin Lesions - Necessary Excision Diameter - (Items 31356 to 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. If secondary intention is used instead of primary closure, an episode of care includes excision and all attendances for wound management.

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.