Oncology & Hematology Coding Alert

Question: Our provider recently removed a benign keratosis. She began by paring it down, then used cryotherapy to finish the removal. In this situation, can we bill for both the paring and the cryotherapy with 11055 and 17110? Or should we bill this another way?

Ohio Subscriber

Answer: You will find a mutually exclusive National Correct Coding Initiative (NCCI) edit prohibiting you from billing 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion) with 17110 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions), so it would not be appropriate to bill both codes in this situation as the procedures were performed at the same anatomic site.

You should only code the most extensive procedure leading to the keratosis’s removal. So, in this situation, you would bill the more comprehensive procedure, 17110.

Also, it is important to point out the lesion was described in the question as benign. As such, the carrier may consider this procedure to be cosmetic and not a covered benefit unless a covered condition meeting medical necessity for the removal is supported and within the third-party’s coverage criteria. Therefore, if coverage of the service is in question, remember to obtain an advanced beneficiary notice (ABN) or waiver of liability for non-Medicare patients as appropriate.