Dermatology Coding Alert

Question: How should I code for laser destruction of penile lesions with CO2 laser when there are 50 or more lesions to treat?

North Dakota Subscriber

Answer: CPT codes 54057 (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; laser surgery) and 54065 (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], extensive [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]) correctly identify the procedure you are trying to code, depending on whether the destruction of the lesions would be classified as simple or complex.

If we assume the lesion destruction was simple, strict interpretation of 54057 indicates that you should only report the code once, regardless of the number of lesions the dermatologist removed. If the dermatologist removed a large number of lesions, however, you may classify the procedure as extensive. Your best option is to call your carrier and ask it whether the number of lesions can designate a procedure as "extensive," in which case 54065 would be the appropriate code. For the above case, you would use 54065 as the proper CPTcode. Also sequence codes 17000 (Destruction [e.g., laser surgery, electro-surgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) to 17111 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of flat warts, molluscum contagiosum, or milia; 15 or more lesions) for similar lesions found in the genital area outside of the area of the penis.