Pediatric Coding Alert

Question: I billed 17003 along with 99213. I added the 25 modifier to the 99213 thinking that would be enough. The 99213 only paid at half its allowable and the 17003 did not pay at all. The denial reason for the 17003 was,“N122 Add-on code cannot be billed by itself.” Is 99213 not acceptable code for 17003?

Rhode Island Subscriber

Answer: Your payer likely denied 17003 because you did not also report its designated base code, 17000 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion).

When you look at the full descriptor for 17003 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)), notice the parenthetical at the end that instructs to list 17003 separately in addition to the code for the first lesion. Code 17003 is used in addition to the code for the first such lesion destroyed, which is 17000. This instruction is reinforced by another parenthetical after code 17003 in CPT^®. That parenthetical states, “(Use 17003 in conjunction with 17000).”

Note also that code 17003 is used for each lesion from two through 14. That means, if your clinician destroyed three premalignant lesions, you would report 17000 for the first one and 17003 two times (or with two units of service, depending on your payer’s preference); once for the second lesion and again for the third lesion.

As for modifier 25, if your clinician did a significant, separately identifiable E/M service in addition to the lesion destructions and the documentation supports that, then you may report the appropriate level of E/M service and append modifier 25, just as you did.