Determining the appropriate lesion destruction code — benign or premalignant
Derm Coding Consult
By Tiffany McFarland, RHIT, Analyst, Coding & Reimbursement, April 1, 2024
Academy coding staff address important coding topics each month in DermWorld Coding Consult. Read more Derm Coding Consult articles.
The distinctions of code choice for lesion destruction — either benign, premalignant, or malignant — are important in dermatology coding. This article, adhering to AMA and CPT® coding guidelines, supplies a comprehensive guide to selecting the correct codes to enhance dermatologists, non-physician clinicians (NPC), and staff members’ coding knowledge for correct claim submission.
Key considerations
Understanding the intent: Destruction procedures aim to remove lesions through various methods like curettage, electrosurgery, cryosurgery, laser, or chemical treatment. The main concept here is ‘ablation’ — the destruction of abnormal tissue with the primary goal being to destroy the lesion.
Diagnose the lesion: After a thorough visual examination of the skin lesion, the dermatologist or NPC, due to the nature of their medical training, can identify the morphology of a lesion as benign or premalignant based on specific lesion characteristics such as size, shape, color, texture, and the patient’s medical history. However, when a definitive diagnosis cannot be established or when a malignancy is suspected, a skin biopsy must be performed. All these factors aid in finding the origin of the lesion and deciding the treatment.
Premalignant skin lesions: Common precancerous skin lesions are actinic keratoses. These types of lesions have a greater risk of developing into skin cancers. Treatment for these lesions may include topical medications, cryotherapy, or laser surgery, which are coded with CPT codes 17000, 17003, and 17004.
CPT Code 17000 is used for the first lesion, add-on code 17003 is used for lesions two through 14. For 15 or more lesions, CPT code 17004 is reported.
Benign vascular lesions: Birthmarks, cherry angiomas, and spider angiomas are non-cancerous growths or abnormalities of the skin and tissues. Laser therapy is a common treatment for vascular lesions. The codes for laser therapy are selected based on the total area in square centimeters (sq cm) rather than the length (cm). It is not appropriate to report codes 17106-17108 for the treatment of lesions such as telangiectasia, cherry angioma, verruca vulgaris, and telangiectasia associated with rosacea or psoriasis.
Other benign lesions: Conditions such as seborrheic keratosis or viral warts are typically diagnosed through visual examination or skin biopsy. Any of the destruction techniques, cryosurgery, chemosurgery, surgical curettement, electrosurgery, or laser surgery can be employed. The surgical procedures for these conditions are reported by CPT codes 17110 – 17111 and are based on the number of lesions that are destroyed.
Avoiding common coding errors
Inappropriate use of modifier 59: Reporting modifier 59 shows procedures/services, other than Evaluation and Management (E/M) services, which are not usually reported together, but are suitable for the circumstances. According to CPT coding guidelines, modifier 59 does not apply to add-on codes when reported exclusively with the primary code. For example, when four premalignant lesions are removed, CPT code 17000 is reported for the first lesion, followed by add-on code 17003 for the second lesion up to 14, reporting each lesion separately. Therefore, resulting in a claim coding sequence of:
17000
+17003 x 3
Inaccurate or incomplete documentation: Benign skin lesion removals can be considered cosmetic procedures. Because of this, it is important to ensure that the documentation supports a medically appropriate and necessary service. According to Medicare, below are examples of lesion characteristics that, when present and documented, will consider the treatment medically necessary:
The lesion is symptomatic with a changing appearance or displays evidence of inflammation or infection.
The lesion obstructs an orifice.
The lesion clinically restricts eye function or interferes with vision.
The likelihood of a diagnosis is uncertain, particularly if malignancy is a realistic assessment based on lesion appearance or prior biopsy of a related or similar lesion suggesting malignancy.
The lesion or cyst has a history of infection, drainage, or rupture.
Keeping up with Academy coding resources and AMA and CMS guidelines is essential for correct coding. Accurate coding does not only streamline billing processes but also enhances patient care management. Remember, attention to details such as the size, number, location, and destruction method of the lesion is essential to reducing denials and delayed reimbursement.
Visit the Academy’s Coding Resource Center for additional guidance and more coding resources.
Coding resources
Get the Academy's 2024 coding resources.
Additional DermWorld Resources
In this issue
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
Opportunities
