Dermatology Coding Alert

Published on Thu Jul 02, 2015 PDF

Our expert answers to your frequently asked steroid questions.

Intralesional injections are near the top of the list of common procedures performed in dermatology practices. When your dermatologist injects a steroid, such as Kenalog or Celestone, into abnormal skin – such as scar tissue – coding may seem straightforward. But as with many coding challenges, there are pitfalls awaiting even the most experienced coder. 

Read on for some frequently asked questions about intralesional injections – and our expert answers.

Question: What CPT® code should I report for intralesional injections?

Answer: Report CPT® code 11900 (Injection, intralesional; up to and including 7 lesions) for seven lesions or fewer, says Pamela Biffle, CPC, CPC-P, CPC-I, CPCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. This code describes an intralesional injection of a corticosteroid, such as triamcinolone acetonide (Kenalog), for treatment of large nodules, keloids, lichenified hyperkeratotic lesions, and numerous other conditions.

For more than seven lesions, report 11901 (… more than 7 lesions).

Question: Can I code separately for the supply of the drug?

Answer: The answer depends on the place of service (POS) setting. In the office (place of service code 11), if your dermatologist purchases the corticosteroid, you can report both 11900 and a code for the medication – e.g., for Kenalog, J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) or J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg). 

Don’t miss: Pay careful attention to the code descriptors when reporting units. For J3300, you should report 1 unit per 1 mg. In contrast, you should report 1 unit per 10 mg for J3301.

If, however, the dermatologist provides the injection in a facility, the facility would bill for the supply of the medicine – the dermatologist would only repot 11900.

Besides Kenalog, other corticosteroids you might see your dermatologist using include:

• Aristocort – J3302 (Injection, triamcinolone diacetate, per 5 mg)

• Celestone – J0702 (Injection, betamethasone acetate 3mg and betamethasone sodium phosphate 3 mg)

• Decadron – J1100 (Injection, dexamethasone sodium phosphate, 1 mg)

Question: How should I code for a 0.05-cc injection of Kenalog into an acne cyst? The HCPCS code only mentions milligrams.

Answer: You need more information. Ask the dermatologist who did the injection how many milligrams he used. Cubic centimeters (cc) are a measure of volume, and milligrams (mg) are a measure of weight.

There’s no consistent way to convert cubic centimeters to milligrams. One drug might have 30 mg per 1 cc; another might have 50 mg per 1 cc.

Once you find out how many milligrams were in the injection, report one unit of HCPCS code J3301 for each 10 mg.

Note: You would use the same HCPCS code regardless of whether the drug is brand-name or generic. Kenalog is the brand name, and the generic drug name is triamcinolone acetonide. The HCPCS tabular listing is arranged by generic drug name. If you look up triamcinolone acetonide in the index, you’ll see it lists J3300 and J3301 as the proper codes. 

Be aware that J3300 is for the preservative-free formulation and matches to different brand names. The HCPCS drug table listing contains brand names, as well. When you look up Kenalog, it refers you to triamcinolone acetonide.

Question: If the dermatologist injects two warts five times each, would I need to report 10 units of 11900?

Answer: CPT® code 11900 specifies the number of lesions treated — in this case, up to and including seven. Your dermatologist only treated two warts, so only one unit of 11900 describes the physician’s work. If the dermatologist treated eight or more warts, you would report one unit of 11901.