ED Coding and Reimbursement Alert

Question: A patient reports to the ED with three plantar warts on his right foot and a lesion with benign pathology on his left elbow. The physician uses cryosurgery to destroy the warts and takes a biopsy of the elbow lesion. Can I report both services, or is the biopsy bundled into the destruction?

Hawaii Subscriber

Answer: You can report both services because they occurred at separate sites. Lesion destruction codes typically include biopsy, but only if the physician performs destruction and biopsy on the same site. You can unbundle the services when the physician performs them on separate sites.

On your claim, you should report the following:

- 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) for the plantar wart destruction

-  078.19 (Other specified viral warts) linked to 17110 to represent the patient's warts

-  11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for the lesion biopsy on the left elbow

-  the appropriate ICD-9-CM code represented by the pathology report linked to 11100 for the patient's lesion.

Also, attach modifier 59 (Distinct procedural service) to 11100 to show that the physician performed the biopsy and destruction at different sites.