Primary Care Coding Alert

Question: A patient had destruction of five basal cell lesions that were .5 cm in size and all on his face, 173.3 (other malignant neoplasm of skin; skin of other and unspecified parts of face). How should this be coded? One option would be to assign CPT code 17280 (destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less) for the first lesion, and 17280-51 (destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less; multiple procedures) for each additional lesion. Another would be to add the lesions together and then report just one code, 17283 (destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm). Are there other options?

Jean Oglevee
Fairfax, Va.

Answer: The CPT guidelines do not allow you to combine the sizes of the lesions in order to use a single code. Although this may be a simple way to combine the lesions, because it is not a true description of the lesions, it could be considered fraudulent billing. There are three methods that you could use to report the services described:

1. 17280 x 5 units
2. 17280 x 1 units
17280-51 x 4 units (modifier -51, multiple
procedures)
3. 17280
17280-59 (modifier -59, distinct procedural service)
17280-59
17280-59
17280-59

The third example is the claim that would be considered the most accurate way to report the procedures. The description of modifier -59 notes that it is used to indicate a different site, which is the message you want to communicate with the insurance carrier. If you use the second option, the carrier may consider the third, fourth and fifth lesions billed with modifier -51 duplicates and deny them.

In any event, you should check with your various carriers to determine which method they prefer. You may also want to submit this claim on paper, and attach the operative and pathology report as documentation.

Coders should be aware that each successive code used would be paid at a reduced rate.

The previous two questions were answered by Cynthia DeVries, RN, BSN, CPC, a coding and reimbursement coordinator for Lee Physicians Group, a 140-provider, multispecialty practice in Fort Myers, Fla.