Pediatric Coding Alert

Question: A 15-year-old girl presents for her annual exam and requests that the pediatrician remove her warts. The physician uses cyrotherapy to remove five warts from the patient's hands and arms. Should I code each removal?

Montana Subscriber

Answer: Yes, you should report all five wart removals.
 
You should code the first lesion that the pediatrician destroys with 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion). This code, however, represents only one lesion removal.
 
For each additional four removals, you should report add-on code +17003 (... second through 14th lesions, each).
 
You don't want to line item each lesion because this may result in denials for duplicate codes. You should instead bill 17000 and then one unit of 17003 for each additional wart. So, your claim should have  17000 with one unit, and 17003 with four units.
 
Tip: If the patient has more than 15 lesions, you simply bill 17004 (Destruction ...; 15 or more lesions). You don't bill 17000 or 17003 in addition to 17004.

For the annual checkup, you should report a preventive medicine service with 99384 (Initial comprehensive preventive medicine evaluation and management of an individual ...) or 99394 (Periodic comprehensive preventive medicine re-evaluation and management of an individual ...) depending on whether the patient is a new or established patient.
 
Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to indicate that the well check is a significant, separate service from the wart removals.