Dermatology Coding Alert

Question: A doctor removed three lesions from the scalp area with surgitron (a device used for radiosurgery) and coated with bacitracin ointment. Do I put them all together into one code even though they are at different sites (3mm, 1mm, and 4mm)?

New York Subscriber

Answer: Code this service as a 'destruction' procedure. Check your documentation to see if the lesions were benign or malignant so you can code the service properly.

For instance, if the three lesions you described were benign, code it 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions). This code describes up to 14 lesions.

Rule of thumb: Never add the lesion sizes together for a destruction or removal. Since the size given is in millimeters, you may have to convert it to centimeters as most coders do. You code each lesion independently, unless of course you are using 17110. If the three lesions are malignant, you would code 17270 (Destruction, malignant lesion [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less), 17270-59 (Distinct procedural service), and 17270-59.

Remember: You should apply modifier 59 when you are billing more than one procedure on the same body area performed at the same session.