Primary Care Coding Alert

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 as 17000 (... first lesion), you would report this code when an FP destroys a seborrheic keratosis lesion.

3. Virus Probably Produced Seed Warts

Seed warts are typically caused by molluscum contagiosum - a viral skin infection that causes raised, pearl-like papules or nodules on the skin.
 
If the FP destroys the lesions on a nonspecified anatomical region, you would assign molluscum contagiosum destruction as 17110-17111 linked to 078.0 (... molluscum contagiosum). Codes 17110 and 17111 specifically refer to destruction of molluscum contagiosum.

Problem: A seed wart may fall into another category. "Go back to the physician and verify that the lesion diagnosis is molluscum contagiosum," Biffle says.
 
The right ICD-9 and CPT code choice depends on whether the wart is a:   

4. Junctional Nevi Need Additional Look

You'll often report nevus treatment as a biopsy (11100). "Most physicians don't destroy nevi," Biffle says.

Why: FPs "treat" nevi mainly to obtain a specimen. "There's always a chance that a nevus that looks like a junctional nevus (M8740/0) is actually atypical," Biffle says.

Exception: The FP could have biopsied (11100) the nevus a week earlier, and the patient may now be returning to have the lesion destroyed.
 
In this case, the physician may use a laser to destroy the nevus.You would report the appropriate destruction code based on the pathology (such as 17000 for benign lesion destruction).

5. Genital Warts Fall Under Area-Specific Codes

You don't want to code genital wart destruction with the integumentary codes. CPT's lesion destruction instructions refer you to "40820, 46900-46917, 46924, 54050-54057, 54065, 56501, 56515, 57061, 57065, 67850 and 68135 for destruction of lesion(s) of specified anatomical sites."

Bottom line: Biffle says, "It's financially advantageous - and appropriate coding - to use the area-specific code" as shown in the benign destruction code chart included with this article.

Editor's note: Because FPs don't usually use 40820, 67850 and 68135, the chart does not include these codes.

Chart reproduced with permission from Pamela J. Biffle, CPC, CCS-P, ACS-DE, approved PMCC instructor, product development director of Custom Coding Books in Bellevue, Wash.