Dermatology Coding Alert

Published on Mon Aug 04, 2014 PDF

17000, 17004 get bundled into dozens of excision and destruction codes.

The next set of edits from the Correct Coding Initiative (CCI), Version 20.1, which go into effect July 1, 2014, will probably have many dermatology coders reaching for their coding edit tables and a red pen.

CCI has determined that dozens of lesion excision and destruction codes are mutually exclusive with two premalignant lesion destruction codes.

CPT® code 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses]; first lesion) has been ruled by CCI to be a mutually exclusive procedure with these codes:

• 11606 — Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm
• 11624-11626 — Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia…
• 17260-17266 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs …
• 17270-17276 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia…
• 17280-17286 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane…

Additionally, CPT® code 17004 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses], 15 or more lesions) has been ruled mutually exclusive with:

• 11300-11303 — Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs…
• 11305-11308 — Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia…
• 11312-11313 — Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane…
• 11400-11406 — Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs…
• 11420-11426 — Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia…
• 11440-11446 — Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane…
• 11450-11471 — Excision of skin and subcutaneous tissue for hidradenitis…
• 11600-11622 — Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia…
• 11640-11641 — Excision, malignant lesion including margins, face, ears, eyelids, nose, lips…
• 11646 — Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm
• 17260-17262 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs…
• 17276 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm
• 17280-17286 — Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane…

By putting these codes in Mutually Exclusive pairs, CCI has determined that the pairs of codes could not or would not be performed at the same session for the same patient. If the two codes in a Mutually Exclusive pair are reported together, only the lesser-valued of the two codes will be reimbursed.

Exception: These codes are marked with modifier indicator 1, which signifies that the two codes in the edit pair can be reported together if the clinical circumstances are appropriate, and if a proper modifier — such as modifier 59 (Distinct procedural service) — is appended to the Column 2 code.

“Separate sites are the only reason that these would be used during the same session,” advises Pamela Biffle, CPC, CPC-P, CPC-I, CPCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. In some cases, she further notes, the provider will perform 17260-17286 with curettage and then follow with liquid nitrogen. “In that case 59 is not appropriate and all services are bundled into the 172xx codes,” she says.