Wiki Curette Removal??

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case21

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Please help!! I have a doc telling me if a lesion is removed with a curette, that he does not need to document the margins because none are taken with the instrument. He states the same thing when lesions are excised in an elliptical fashion. Can anyone verify if these two statements are true? If they are or are not... Is there somewhere I can find documentation that supports this?
Any words of wisdom would be greatly appreciated :eek:
 
CPT 17000 states destruction (eg laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement,) premalignant lesions (eg actinic keratoses); first lesion. CPT 17003 is lesions 2-15 and CPT 17004 if 15 or more lesions. These codes are not dependent on size or location of lesion. You just need to know how many were destroyed.

CPT 17260-17286, Destruction, malignant lesion ((eg laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement,) would be determined by size and location of lesions.

Your code selection is going to be based on what type of lesion, premalignant versus malignant. If malignant, then you will need the size and the location of the lesions.

Hope this helps.
 
Thanks so much for your response Pygreen. I should have been more specific. He is trying to bill the excision of a benign lesion removal. CPT guidelines clearly state that you need the diameter of the lesion as well as the sum of the margins to code, however he argues that when excised with a currette or in an elliptical fashion... there is no need for the margins to be documented:confused:
Is there proof of this anywhere?
 
Should I just code the 17110 rather than the 11400-11442 codes in these instances (if they're benign of course)? That's what it's sounding like...
 
CPT states the 11400-11446 are excisions. The description of excisons in the CPT book state "Excisions is defined as full-thickness (through the dermis) removal of a lesion, including margins. Without seeing the OP note, if he just did a surgical curettement, and the lesion is benign, then 17110 would appear to be the correct code.
 
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