Dermatology Coding Alert

Question: Eight days after an initial wart freezing, the patient returns, and the dermatologist again freezes the same wart. Is the second procedure bundled into the first, or can we report it with a modifier?


Oregon Subscriber

Answer: You may be able to report the second occurrence of 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) if the documentation for the first procedure specifies that the treatment will take more than one session.

Medicare assigns 17000 a 10-day global period, so the patient in this case definitely had a second procedure within the global period of the first.

Append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) if the dermatologist planned at the initial procedure to re-freeze the wart during the postoperative period.

If the dermatologist did not plan the second procedure at the time of the first, try appending modifier 76 (Repeat procedure by same physician) to the second procedure.