# Risk factor for destruction of lesions?



## SUN1633 (Mar 16, 2018)

Hi,
We are having a debate whether destruction of benign or malignant lesions 17000-17110 are considered a *Minor Surgery WITH Identified Risk Factors, or Minor Surgery WITH NO Identified Risk Factors* under the Management Options category when coding EM levels. 
For example sake, lets say pt otherwise has 3 additional diagnoses plus treatment for AK,  a Detailed History and EPF skin exam, no additional treatment. 
Note says pt was told what to expect after the procedure (blistering, bleeding, flake and fall off in a few days etc) and pt is given post treatment instructions. We have considered this under LOW risk (minor surgery with no identified risk factors) and are being told it should be considered as MODERATE with identified risk.

How would you consider the risk factor for this type of procedure and why? 
Thanks!


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## thomas7331 (Mar 16, 2018)

I would agree with you that this scenario would be low risk.  I've always understood 'identified risk factors' to mean specific patient conditions or comorbidities that increase the risks of the surgery to that particular patient, not the standard risks that always accompany a procedure for any patient.  So for example, if this patient was taking an anti-coagulant medication or had a condition that was documented as contributing to an increased risk for bleeding or healing after the procedure, that could be considered an identified risk factor that could warrant moderate level risk.


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## ellzeycoding (Mar 16, 2018)

I agree with Thomas.

The identified risk factors are associated with the patient, not the procedure itself.

Examples... patient has difficulty healing.  patient has a bleeding disorder... patient has an occupation that may disrupt the surgical wound due to excessive movement, etc.  The patient's risk factor should be documented in the medical record.


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## CatchTheWind (Mar 26, 2018)

But in this case, since the destruction of AKs was performed the same day, you can't include the decision to perform surgery as part of the E/M anyway, since it's included in the surgery.


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## ellzeycoding (Mar 26, 2018)

CatchTheWind said:


> But in this case, since the destruction of AKs was performed the same day, you can't include the decision to perform surgery as part of the E/M anyway, since it's included in the surgery.



Exactly true.

Thomas and I were clarifying "identified risk factors" and that the risk factors are due to the patient, not the procedure itself.  Every surgery  has some inherent amount of "risk factor"...

But the last poster is correct.  17000/17003/171110/17111 are minor procedures and the E/M that leads to the decision to perform them are included in the procedure itself.  True for New and Established patients.

You would code an E/M for a separately identifiable issue (i.e., unrelated to the destruction) and you wouldn't be factoring in the MDM for the destructions into the E/M as the MDM for the destructions is built into the destructions.


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## brandytony (May 23, 2018)

*17110*

Can someone tell me if a biopsy would be included in this CPT 17110 and not coded separately?


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## ellzeycoding (May 23, 2018)

brandytony said:


> Can someone tell me if a biopsy would be included in this CPT 17110 and not coded separately?



You cannot bill for the biopsy (11100) if you do the destruction. They are bundled.   

You can certainly curette a small sample prior to destruction and submit it for pathology (88304/88305).  But you cannot bill both the biopsy and destruction on the same lesion.  Ultimately you destroyed it, so bill the 17110.


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## brandytony (May 23, 2018)

*17110*

Thank you. I am assuming this would be with any destruction done that something may be sent for biopsy.....we could summit the pathology codes?


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## ellzeycoding (May 23, 2018)

Yes.  You can bill 17110/88305 for example.  

But not 17110, 11100, 88305, as the destruction and biopsy (11100) are bundled according to the NCCI edits.


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## Sburton828 (Jan 2, 2019)

*What about path for an ED&C that is benign?*



ellzeycoding said:


> Yes.  You can bill 17110/88305 for example.
> 
> But not 17110, 11100, 88305, as the destruction and biopsy (11100) are bundled according to the NCCI edits.



If path for ED&C comes back as benign would you change the CPT to 17110 with the benign dx?


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