Primary Care Coding Alert

     

















This chart shows you when to use higher-paying site-specific lesion codes You can minimize lesion-claim submission delays if you familiarize yourself with corresponding CPT codes for five complicated diagnoses.

Distinguishing between biopsy and lesion destruction codes can plague the most experienced family physician coder. But when the diagnoses are melanotic nevi, seborrheic keratosis, genital warts, seed warts and junctional nevi, the decision becomes even harder, says Donna Moss, coder at a family physician clinic in Kansas City, Kan.

Decide whether you should report a biopsy or destruction code for the following diagnoses. Hint: Use these clues to choose the right CPT and ICD-9 code:

1. If the FP biopsies or takes a small piece of neoplasm to obtain a diagnosis, report 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) or +11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]).

2. When an FP destroys an entire lesion to eliminate it, you should use a destruction code, such as 17000-17004 (Destruction [e.g., laser surgery, electrosurgery, cryo-surgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions ...) or 17110-17111 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of flat warts, molluscum contagiosum, or milia ...).
  Use the first set (17000-17004) when the FP destroys a benign or premalignant lesion other than a skin tag, such as actinic keratoses (702.0).
  Choose a code from the second set (17110-17111) when the FP destroys flat warts (078.10, Viral warts, unspecified), molluscum contagiosum (078.0) or milium (whitehead) (706.2).
  Exception: For lesion destruction of anatomical regions, you should instead report the higher-paying site-specific code, such as 46900 (Destruction of lesion[s], anus [e.g. condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical). 1. Melanotic Nevi Require Further Identification To identify the correct CPT code to use with a diagnosis of melanotic nevi (M8720/0), you should double-check the chart note. Look for whether the FP biopsied the lesion to discover the lesion's type or destroyed the lesion to remove it completely.

"Usually, a physician wants to send melanotic nevi to the lab for diagnosis," says Pamela J. Biffle, CPC, CCS-P, ACS-DE, approved PMCC instructor, product development director of Custom Coding Books in Bellevue, Wash. So he'll probably perform a biopsy (11100).
 
2. Seborrheic Keratosis Is a Benign Skin Lesion You'll most likely report a destruction code with a seborrheic keratosis lesion. "A physician usually destroys a lesion that has a diagnosis of seborrheic keratosis (702.11, Inflamed seborrheic keratosis or 702.19, Other seborrheic keratosis) with cryosurgery," Biffle says.

A seborrheic keratosis lesion is a type of benign skin tumor. Because CPT defines destruction of a benign skin lesion [...]