Dermatology Coding Alert

Published on Thu Aug 13, 2015 PDF

Question: Our dermatologist destroyed 13 molluscum contagiosums and shaved a 0.4 cm mole on the patient’s upper arm. What should I report?

Pennsylvania Subscriber

Answer: Do not use only CPT^® code 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) for this scenario. You should report a separate code for the shave.

Shaving of epidermal or dermal lesions, which is literally shaving off a lesion using a sharp instrument, falls under CPT^® codes 11300-11313 (Shaving of epidermal or dermal lesion, single lesion…).

For the above case, based on the lesion’s location (arm) and size (0.4 cm), you would use CPT^® code 11300 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less), which contains 2.74 non-facility total relative value units (RVUs) using the 2015 Medicare Physician Fee Schedule. Multiplying the RVUs by the 2015 conversion factor of 35.9335 shows approximately $98 in reimbursement.

Destruction of benign lesions including molluscum contagiosums counts as 17110-17111 depending on the number of lesions the physician destroys. For destruction of up to 14 lesions, use 17110, which contains 3.12 RVUs and pays approximately $112. For destruction of 15 or more lesions, report 17111 (… 15 or more lesions; 3.70 RVUs). Be careful: Do not use 17111 in addition to 17110.

Tip: You may need to use modifier 51 (Multiple procedures) to indicate the destruction is a multiple procedure. Append modifier 51 to the lesser-valued procedure: 11300-51. Complete procedural coding could include 17110, 11300-51. Some insurers may follow Medicare’s multiple procedure reduction and pay 11300 at 50 percent, which would equate to approximately $49.