Pediatric Coding Alert

Treating 17110 as your office's catch-all skin lesion destruction procedure code could cut $30-$72 from a claim.

As pediatricians look for more ways to maximize services provided in our medical homes, understanding correct coding for skin lesion destruction becomes more important. You could be overlooking providing dermatology procedures that could benefit your bottom line. Here are some to look into -- and how to code them appropriately.

Destruction, which means the ablation of tissues of lesions, is by any method; some methods are code specific, said Robin Linker, CHCA, CPC-I, CPC-H, CCS-P, MCSP, CPC-P, RMC, RMM, CHC, in her "Pediatric Coding Challenges" American Academy of Professional Coders' presentation. "Often destruction will require more than one code and/or units to report the service."

To tell them apart, try your hand at two cases.

Question 1: A pediatrician destroys 13 molluscum contagiosums on a 5-year-old and shaves a 0.4 cm mole on the patient's upper arm. Should you use only 17110?

Answer 1: No, thinking you should lump both the shaving and the destructions into one code will cut approximately $30 from the claim. You should report a separate code for the shave.

Shaving of epidermal or dermal lesions, which is literally shaving off a lesion using a sharp instrument, falls under 11300-11313 ("Shaving of Epidermal or Dermal Lesions"), says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.

For the above case, based on the lesion's location (arm) and size (0.4 cm), you would use 11300 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less), which contains 1.67 transitional non-facility total relative value units (RVUs) using the 2009 Medicare Physician Fee Schedule.

Destruction of benign lesions including molluscum contagiosums counts as 17110-17111 depending on the number of lesions the physician destroys. For destruction of up to 14 lesions, use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions), which contains 2.70 RVUs and pays approximately $97. For destruction of 15 or more lesions, report 17111 (... 15 or more lesions; 3.20 RVUs). Be careful: Do not use 17111 in addition to 17110.

Tip: You may need to use modifier 51 (Multiple procedures) to indicate the destruction is a multiple procedure. Append modifier 51 to the lesser-valued procedure: 11300-51. Complete procedural coding could include 17110, 11300-51. Some insurers may follow Medicare's multiple procedure reduction and pay 11300 at 50 percent, which would equate to approximately $30.