Wiki CPT 10040 vs 17360

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Metroderm

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I would like to get an opinion for other coders about the note below.
My coworker and I have disagreement on the code between 10040 x 17360
I'm on 10040 side because we did extraction with cotton tipped applicator, but my coworker's saying that it should be 17360 is correct because they is incision for extraction and used salicylic acid, so this visit is valid for cpt 17360.
I would like to hear your opinion. Please help.

Acne Vulgaris (L70.0) distributed on the right inferior central malar cheek and left inferior central malar cheek.
Overall Assessment: 3.0 - multiple inflammatory lesions but noninflammatory lesions predominate

Plan: Acne Surgery.
Comedonal Lesions located on the right inferior central malar cheek and left inferior central malar cheek were removed with cotton-tipped applicators and gentle pressure.
Prior to the treatment, the treatment area(s) was/were prepared in the usual fashion. Salicylic acid 20% was applied to the entire face for 2 minutes.
Sunscreen and face emollient cream was applied. SAAS treatment #1/3
Consent was obtained and risks were reviewed including but not limited to scarring, infection, bleeding, scabbing, incomplete removal, and allergy to anesthesia.
 
The documentation you provided more strongly supports a 10040, which is "Acne surgery - e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, and pustules". An argument could be made for billing the 17360, which is described as "Chemical exfoliation for acne (e.g., acne paste, acid)", but IMO, using SA to prep is not the same as chemical exfoliation, which is considered by most insurance companies to be a cosmetic procedure and not medically necessary.
 
sinman0531 said:
The documentation you provided more strongly supports a 10040, which is "Acne surgery - e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, and pustules". An argument could be made for billing the 17360, which is described as "Chemical exfoliation for acne (e.g., acne paste, acid)", but IMO, using SA to prep is not the same as chemical exfoliation, which is considered by most insurance companies to be a cosmetic procedure and not medically necessary.
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Thank you so much for the reply. I'm still arguing with one of the provider who insists. May I ask what is the proper preparation for the chemical exfoliation? So that I can tell the provider the difference of those two. Thank you.
 
Metroderm said:
Thank you so much for the reply. I'm still arguing with one of the provider who insists. May I ask what is the proper preparation for the chemical exfoliation? So that I can tell the provider the difference of those two. Thank you.
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Sorry this took me so long! So since the 17360 is pretty much always going to be considered not medically necessary, it really doesn't matter how you word it in the medical record. You can bill it if you want just to prove a point, but I did find this in the 2019 Coders Desk Reference from Optum we have at my practice:

"The physician makes a small incision through the skin overlying a lesion, or multiple lesions, such as comedones (blackheads), cysts, or pustules for acne surgery. The skin over the lesion is removed. The lesion is opened with a surgical instrument and the fluid is drained for secondary healing. The lesion may be removed or marsupialized by exteriorizing the cyst and making a pouch where it used to be enclosed. No sutures are needed. Do not bill a benign lesion excision code (11400-11446) and chemical exfoliation for acne (17360) on same date of service with 10040."
 
sinman0531 said:
Sorry this took me so long! So since the 17360 is pretty much always going to be considered not medically necessary, it really doesn't matter how you word it in the medical record. You can bill it if you want just to prove a point, but I did find this in the 2019 Coders Desk Reference from Optum we have at my practice:

"The physician makes a small incision through the skin overlying a lesion, or multiple lesions, such as comedones (blackheads), cysts, or pustules for acne surgery. The skin over the lesion is removed. The lesion is opened with a surgical instrument and the fluid is drained for secondary healing. The lesion may be removed or marsupialized by exteriorizing the cyst and making a pouch where it used to be enclosed. No sutures are needed. Do not bill a benign lesion excision code (11400-11446) and chemical exfoliation for acne (17360) on same date of service with 10040."
Click to expand...
I'm so sorry for the late reply. I've read your response and notified to the provider. Thank you again for the response.
 
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