Dermatology Coding Alert

Question: How should I code for CO2 laser dermabrasion to treat a basal cell carcinoma?

Pennsylvania Subscriber

Answer: Report 15780 (Dermabrasion; total face [e.g., for acne scarring, fine wrinkling, rhytids, general keratosis]), 15781 (... segmental, face), 15782 (... regional, other than face), or 15783 (... superficial, any site) for a dermabrasion procedure.

To show that the procedure is medically necessary, link the CPT code to an ICD-9 code from the 173.0-173.9 series (Other malignant neoplasm of skin). Pick the code from that series that represents the site of the carcinoma.

Warning: Most carriers consider dermabrasion procedures to be cosmetic and will reimburse you for them only under certain medical circumstances. For example, Aetna considers dermabrasion -- whether by dermaplaning or CO2 laser -- medically necessary "for removal of superficial basal cell carcinomas and pre-cancerous actinic keratoses" only when you meet two criteria:

• conventional methods of removal such as cryotherapy, curettage, and excision are impractical due to the number and distribution of the lesions, and

• the member has failed a trial of 5-fluorouracil (5-FU) (Efudex), unless contraindicated.