Wiki 17110 and 96405 on one lesion

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JesseL

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Provider uses cryo gun on a wart and also injects 5fu into the same wart.

Is it okay to bill 17110 (destruction benign lesion) and 96405 (injection to lesion, chemo agent) together?

I looked at the NCCI edits and there's no conflict. Does that mean the service is billable together even though its all done on one lesion?

I find it odd they bundle if billed with 11900 (for steroidal injections) but not for 96405.
 
I suspect the reason there is no NCCI edit is because 17110 is for a benign lesion and 96405 would normally be for treatment of a malignancy. Though the two do not bundle, you may have a medical necessity problem if billing a chemotherapy injection to a lesion with a benign diagnosis.
 
I don't think the code limits too malignant diagnosis. The cpt says "non cancer diagnosis" but I still use the same code for malignant lesions.. (to be honest the CPT description is confusing to me)


I also came across this a while back:

Chemotherapy Administration: It is important to distinguish the treatment of a lesion by injecting a steroidal drug (11900-11901), from intralesional chemotherapy, which is reported with the codes listed below. These codes follow the same reporting rules as the 11900 series.

96405 - Chemotherapy administration, intralesional; up to and including 7 lesions
96406 - more than 7 lesions

http://health-information.advancewe...Q-and-A/Ask-the-Experts-November-17-2014.aspx
 
I was looking at this yesterday and was doing a little research on 5fu and it is a chemotherapeutic agent for use on malignancies but it was also listed has a use for treating warts. Thinking from the medical waste and abuse side. What is the medical necessity to using two completely different treatment methods on the same lesion?

PS just because there are no associated CCI edits doesn't mean its correct coding. Its not a open invitation to bill both codes.
 
it was a large wart I suppose that the patient would benefit from doing both as oppose to solely aggressively spraying cryo on the wart. Probably 5fu injection takes care of the root of the wart too if it were deep down, being how persistent viral warts are the injection may also improve the odds of completely getting rid of the wart in combination of cryo. I'm no doctor but I'm assuming that's the reasoning.. The provider always does this on large warts usually. I've only been billing 17110 alone assuming the injection was bundled.
 
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If it's medically necessary and an approved use of the drug, I can't see any reason that you would not be able to bill it. If there is no NCCI edit, that tells you it is not considered mutually exclusive and the value assigned to the procedure does take into account the additional work of the injection, so I would consider it appropriate to report separately.
 
thomas7331 said:
If it's medically necessary and an approved use of the drug, I can't see any reason that you would not be able to bill it. If there is no NCCI edit, that tells you it is not considered mutually exclusive and the value assigned to the procedure does take into account the additional work of the injection, so I would consider it appropriate to report separately.
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That's what I thought but not confident if it's correct to bill both.
 
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