Pediatric Coding Alert

Question: I am confused about which CPT^® code to use for milia destruction and the correct ICD-10 code to link for the diagnosis. The pediatrician’s note says that she used a chemical peel, but the only CPT^® code I can find that mentions milia is 10040, which is an I&D removal code. Additionally, I can’t seem to find milia in the ICD-10 index. Which codes should I use?

Arizona Subscriber

Answer: You are correct in thinking that both codes you mention are not the correct ones to use when documenting milia removal. CPT^® code 10040 (Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) may mention milia, but as you say, this is an incision and drainage (I&D) code, meaning the provider uses an instrument such as a blade or a fine-tipped needle to make an incision and drain the lesions, and not a chemical peel, which is the typical way to remove milia.

In fact, if your physician uses a chemical agent such as hydroxy or salicylic acid, then you should use 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) or 17111 (... 15 or more lesions), depending on the number of lesions your pediatrician removes.

As for the correct ICD-10 code for milia, the ICD-10 index confusingly lists the condition under its singular form, “milium,” rather than the plural “milia.” This leads you to L72.0 (Epidermal cyst).