Wiki E/M with procdure

[vhammons]

Am I understanding correctly that if someone comes in to have a wart removed, and it ends up not being a wart and considered a lesion and we remove it that we bill only the excision? My employer is wanting to bill an E/M code also. I used code 11426 for excision and she wants to use 99213 also. They did not address anything else in the visit, just the wart/lesion. Thanks for any help!

 

[AprilSueMadison]

If the provider didn't meet the below qualifications or they weren't documented, then you still have a destruction of a benign lesion.

The CPT distinguishes a simple excision (codes 11400 11646) from a biopsy or shave via two criteria:

The excised lesion must be removed through the dermis (i.e., into subcutaneous tissue).
The excision includes margins.

17110 is:

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS

If the lesion is the only thing addressed and a procedure was done on said lesion with a global of 000, 010, or 090....then yes, you can only bill for the procedure. You will not be able to bill for an office visit unless the exam went above and beyond the normal work for the procedure.

 

[vhammons]

Thank You, that is what I was thinking. I haven't been doing this very long and I question myself sometimes!