Internal Medicine Coding Alert

Question: Our physician used glycolic acid to remove actinic keratoses from around a patient's eyes and face. How should I code this?

Arkansas Subscriber

Answer: The procedure you describe is also known as a chemical peel. You should report this procedure with 15788 (Chemical peel, facial; epidermal) for the removal of wrinkles and abnormal pigmentation using a chemical agent.

However: If you receive a denial, check whether your physician administered chemical peel treatment for the purpose of necessity or cosmetic reasons. Important: You should always code the diagnosis your physician provides for the chemical peel.

For instance, suppose, as in your case, the internist did the chemical peel for actinic keratoses (702.0). Did you accidentally report 702.19 (Other seborrheic keratosis) which represents non-symptomatic seborrheic keratosis? CMS considers the removal of 702.19 as cosmetic unless the growth is bleeding, painful, intensely itchy, purulent, or impairs the patient's function in some other way. In that case the correct ICD-9 code would be 702.11 (Inflamed seborrheic keratosis).

On the other hand, actinic keratoses (AK) are precancerous and removal is always medically necessary. Because there are non-surgical treatments for AK, there may be coverage decisions based on the type of treatment rather than the diagnosis, as is often seen. For instance, physicians may treat AK using cryosurgery with liquid nitrogen, topical drug therapy, and curettage. Just the same, Medicare accepts less-popular methods of treatment, including dermabrasion, excision, laser therapy, photodynamic therapy (PDT), and chemical peels.