Dermatology Coding Alert

Question: We're seeing an increase in Medicare denials for destruction of lesions on the face. For example, a patient has a 0.4-cm lesion on his left forehead, a 0.2-cm lesion on his left cheek, a 0.6-cm on his right scalp area and a 2.0-cm lesion on his chin. Should I code these individually or sum up the sizes? We've tried to sum up the lesions as a total but have received denials asking for a "breakdown of charge" from the carrier. When we code individually, Medicare denies our claim as duplicate claims.

North Carolina Subscriber

Answer: Your note states these are "destruction" of lesions, not "excisions." If this is the case, you should choose from the 17000 series of codes (destruction codes) in the integumentary section of the CPT manual. 

These codes refer to the destruction of benign and premalignant lesions. If the dermatologist removed malignant lesions, you should use codes from the 17260-17286 series (destruction of malignant excisions). You should never add lesions together when the dermatologist destroys the lesions. You should report each lesion separately with the appropriate modifiers.

The codes specify: "Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses), other than skin tags ..." Therefore, you should report 17000 for the first lesion and then the add-on code 17003 for the second through 14th lesions, each. Using these codes your bill should look like this: 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) x 1 (forehead) and 17003 (Destruction, all benign or premalignant lesions other than skin tags or cutaneous vascular proliferative lesions; second through 14th lesions, each) x 3 (cheek, scalp, chin).

Bonus: Don't forget to add modifier -59 (Distinct procedural service) to 17003.