# Multiple derm procedures



## june616 (Oct 20, 2013)

I need help billing out this claim with multiple skin procedures. I work in family practice so we usually only see one, maybe two, procedures done at one visit. I'm pretty confident that the dx and cpt codes are correct, I want to make sure I've used to the modifiers properly. The #'s in the parenthesis are the Dx pointers. The claim is going to BCBS, if that matters.

(1) 239.2
(2) 078.10
(3) 702.0
(4) 702.11

(1) 11301
(1) 11301 -59
(4) 11301 -59
(2) 17110
(3) 17000
(3) 17003


Any help pointing me in the right direction would be great! PS I'm enjoying this opportunity to learn more and more about derm coding. It's fun!


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## mitchellde (Oct 20, 2013)

without the documentation it is hard to know, the procedure codes look good, I am wondering as to the use of the 239.2 dx code, this code can be assigned only if the provider documents that this is a growth or a tumor.  Look in the ICD-9 book and it will tell you that the term "mass" ( meaning mass , lump. lesion. bump, etc) is not to be regarded as a neoplastic grown.  If the provider describes a skin lesion or disorder then you must use a 709 code.


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## june616 (Oct 20, 2013)

Ok, thank you! I will review the notes again when I'm back at work and see if that dx needs to be changed. Thanks again!


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## sarahandross@rocketmail.com (Nov 3, 2013)

*Excisions*

You also need a 59 modifier on your 17000. 2392 is generally only used on a biopsy of 11100. You would need to find out what he removed on your excision codes and use the appropriate dx. I code dermatology and we do have a few providers that do excisions and choose to use a 2382 or a 2392 dx. Good luck.


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## Texascoder64 (Nov 17, 2013)

also 59  mod on 17000 and 17003


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## mitchellde (Nov 17, 2013)

sarahandross@rocketmail.com said:


> You also need a 59 modifier on your 17000. 2392 is generally only used on a biopsy of 11100. You would need to find out what he removed on your excision codes and use the appropriate dx. I code dermatology and we do have a few providers that do excisions and choose to use a 2382 or a 2392 dx. Good luck.



I do understand that providers do chose codes, however they are often chosen in error.  You must code based on the narrative diagnosis in the chart note and follow the code definitions per the ICD classification system.  238 codes require the benefit of a path report and 239 codes need a preliminary diagnostic study with a diagnosis of a growth or tumor.  Look in your codebook for confirmation of this.  you cannot code an excision until you have a path report rendered.  You cannot guess at the excision code of benign or malignant you must have a path report to know.


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## sarahandross@rocketmail.com (Nov 19, 2013)

17003 does not need a 59 modifier as it is a add on code to the 17000


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## fammed@qwestoffice.net (Feb 27, 2014)

REALLY CURIOS HOW YOU ENDED GETTING PAID ON ALL OF THOSE SKIN REMOVAL AND EXCISONS?

1)173.31
2)692.74
3)706.8

17281 (1)
17281-59 (1)
17280 (1)
17280-59 (1)
17271 (1)
17000-59 (2)
17003 (3)

THIS IS WHAT I HAVE, AND HAVE BEEN WAITING TO SEND, BECAUSE I AM SO UNSURE OF THE WHOLE THING!  HAVE ANY ANSWERS HELP!


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## JesseL (Mar 1, 2014)

Why are the solar dermatitis code and xerosis code linked with destruction of premalignant lesion?


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