REIMBURSEMENT:
Keep Number Of Units Straight For 17003 and 17111
Published on Sun Mar 25, 2007
Only one diagnosis will get you paid for 17000-17004.
Heads up: Relying on your carrier's local coverage determinations (LCDs) could cost you some big repayments later on.
CPT 2007 changed the descriptors for some lesion destruction codes. Starting last January, codes 17000-17004 apply to only premalignant lesions. And 17110-17111 apply to only benign lesions. That means the only diagnosis code you can use with 17000-17004 is 702.0 (Actinic keratosis).
But many carriers still haven't updated their LCDs, meaning they're still accepting other lesion diagnosis codes for 17000-17004. You might get paid if you use one of those other diagnosis codes, but don't spend all that money right away. You might need to pay it back later, say coding experts.
It's possible some carriers haven't yet set up edits to catch 17000-17004 with a non-premalignant diagnosis, notes Jetton Torrix with Knowledge Source Seminars in Star, ID.
But because the code description for 17000-17004 clearly states premalignant lesions, coders "will be in trouble with a non-premalignant diagnosis," says Jan Rasmussen with Professional Coding Solutions in Eau Claire, WI.
"Just because you get paid doesn't mean it is correct and that they won't be asking for the money back," says Pam Biffle, director of operations for the Coding Resource Network Institute in Salt Lake City, UT.
Also, many carriers seem to have "blanket" LCDs for lesion treatments, notes Wendy Weisel with the Department of Dermatology at the University of Virginia Health Services. Looking at the Trailblazer LCD, it appears the carrier won't do an individual LCD for each procedure, including destructions, excisions or removals. Still, she frequently sees physicians using the incorrect diagnosis code for lesion destruction.
If you've been incorrectly using 17000-17004 for lesions other than premalignant ones, you "should notify carriers of this error and work with them to rectify the errant billing," urges Joanne Wolf, coding manager with the Children's Physician Network in Minneapolis. Bill Multiple Units Of CPT 17003 Watch out: You could be missing out on your rightful reimbursement if you're not billing for multiple units of premalignant-lesion destruction code 17003. "This is one of the most common billing errors," says Torrix.
The problem: You use CPT code 17000 when there's just one lesion, plus one unit each of 17003 for each additional lesion up to 14. But if there are 15 or more lesions, you use just one unit of 17004 and don't bill 17000 or 17003 at all.
"You should report a single unit of 17000 for the first premalignant lesion the physician destroys," said Daniel Mark Siegel, during a Nov. 16, 2006, presentation at the American Medical Association's CPT and RBRVS 2007 Annual Symposium in Chicago. "You would then apply a single unit of 17003 for each of the second through 14th [...]
