General Surgery Coding Alert

Question: A man has presented with a keloid from a cyst in sternal area of the chest from a removal 10 years ago. The keloid is 10 centimeters and the patient needs to keep it covered because of the irritation of rubbing against from his shirt. So the physician wants to do steroid injections with laser treatment for five sessions to reduce the volume of the keloid. Then he wants to excise it with a flap closure. The solution of steroid he is using is methylprednisolone acetate, approximately 3 ccs. I coded the excision as 11406 and used 14000 for the flap closure.However, I am totally unsure how to code the laser and steroid injection. What codes should I report?

New Jersey Subscriber

Answer: First, you cannot code 11406 (Excision,benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter over 4.0 cm) with 14000 (Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less). Adjacent tissue transfer codes include excision of the lesion unless the surgeon performs the procedures at a different session. Therefore, you should report just 14000 for the excision and flap closure.

For the injection, look at code 11900 (Injection,intralesional; up to and including seven lesions). This code is usually used for intralesional injections of chemotherapy drugs but there is no reason it couldnt also be used for steroids.

Additionally: For the laser treatment, 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery,chemosurgery, surgical curettement],premalignant lesions [e.g., actinic keratoses]; first lesion) may be the most appropriate code to report. The question does not explain how your surgeon used the laser to treat the scar. Assuming that this was partial destruction with subsequent excision, 17000 would be the best code.

Caution: Most likely your surgeon did not perform all of these procedures on the same day. If he did, then youll have issues reporting 17000 and 14000 together, as payers bundle those codes.

Important: You cannot append modifier 59 (Distinct procedural services) because these procedures were all for treating the same lesion. Also, some of these codes will have global periods (which may vary depending on payer) so modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) will be appropriate for services planned to be performed in stages over several different dates.