Part B Insider (Multispecialty) Coding Alert

Bonus:  You may be able to reap nearly $200 in reimbursement

Actinic keratoses (AK) are more common than you may think, so it helps to know that top-notch coding for this condition often depends on the number of lesions. Here's why.

"Medicare covers the destruction of actinic keratoses without restrictions based on lesion or patient characteristics," says the Medicare Coverage Issues Manual, section 35-101. "Commonly performed treatments for AKs include cryosurgery with liquid nitrogen, topical drug therapy and curettage. Less commonly performed treatments for AK include dermabrasion, excision, chemical peels, laser therapy and photodynamic therapy (PDT)."

Caution: Don't confuse AK with 702.11 (Inflamed seborrheic keratosis), a non-cancerous skin growth. Unlike AK, Medicare does not always cover a dermatologist's removal of a seborrheic keratosis. CMS usually considers the removal cosmetic unless the growth is bleeding, painful, intensely itchy, purulent or impairs the patient's function in some other way.

The most common treatment for AK is cryotherapy, and you should report 17000 (Destruction, all benign or premalignant lesions...) for the first AK lesion the dermatologist treats with cryotherapy. If the dermatologist finds more than one lesion, report +17003 (...second through 14th lesions...) once for each additional lesion 2-14, says Pamela J. Biffle, CPC, CCS-P, dermatology coding consultant and president of PB Healthcare Consulting and Education in Fort Worth, TX.

More lesions: If the dermatologist destroys over 15 AKs, report one unit of 17004 (Destruction ... all benign or premalignant lesions other than skin tags or cutaneous vascular proliferative lesions, 15 or more lesions) alone. To reimburse for the work involved in destroying over 15 lesions, Medicare assigns 5.21 nonfacility RVUs to 17004, compared with 1.60 assigned to 17000. Multiplying 5.21 by the conversion factor, 37.8975, yields $197.44 for one unit of 17004.