Dematology codes 17000 170003

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The CPT book is being interpreted 2 different ways. Review of CPT codes 17000 and 17003.
I believe this means that if the lesions are in the same body area for a removal of 5 we would bill a 17000 and a 17003 X1. If we are removing lesions in a separate body area we may bill more.
Example 5 lesions removed from the head and 6 removed from the foot, we would bill
17000 and 17003X1 and 17000 -59 and 17003 X1- 59.

Or would we bill 17000 and 17003 x 9

Can anyone tell me if this is the correct way to bill these codes?
 

missy874

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17000 and 17003 x 9

its per lesion and does not state anything about location.

The 59 comes into play when there are excision codes and you have different lesions (either on same body area or different body area)
 

mitchellde

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The CPT book is being interpreted 2 different ways. Review of CPT codes 17000 and 17003.
I believe this means that if the lesions are in the same body area for a removal of 5 we would bill a 17000 and a 17003 X1. If we are removing lesions in a separate body area we may bill more.
Example 5 lesions removed from the head and 6 removed from the foot, we would bill
17000 and 17003X1 and 17000 -59 and 17003 X1- 59.

Or would we bill 17000 and 17003 x 9

Can anyone tell me if this is the correct way to bill these codes?
These codes are per destruction of a lesion without regard to body area, if a total of 6 lesions are destroyed in various body locations they you bill for a total of 6
17000
17003
17003 59
17003 59
17003 59
17003 59
the 59 modifier is not only for excisions you use it on the second and subsequent 17003 to keep them from denying as a duplicate. you can have a maximum of 14, if your provider destroys 15 or more then you do not use either the 17000 or the 17003, you use the 17004 only with 1 unit.
 

missy874

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I agree that I would use the 59 in that manner Debra, sorry. We bill the
17000 and
17003 X 5

so the 59 doesnt have to come into play when we just change the # of units.
 

cstinson

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I don't ever bill a 59 on these. I just use 17000 for the first one and 17003 with the quantity done. It's a lot less confusing for insurance companies this way as well. if it's 15 or more Ak's destoryed then you only need code 17004.:)
 

mitchellde

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The only problem with using units is I have found that several payers do not pay for each one like they do when I list them separately, also the CPT manual instructs you to list them separately, and I have had clients that recently have received denials due to units greater than 1 when they insisted on billing with units. I like to touch a claim only one time and I can guarantee that listing them separately will pay without question to the most optimal dollar allowed
 

CFisher5

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The CPT book is being interpreted 2 different ways. Review of CPT codes 17000 and 17003.
I believe this means that if the lesions are in the same body area for a removal of 5 we would bill a 17000 and a 17003 X1. If we are removing lesions in a separate body area we may bill more.
Example 5 lesions removed from the head and 6 removed from the foot, we would bill
17000 and 17003X1 and 17000 -59 and 17003 X1- 59.

Or would we bill 17000 and 17003 x 9

Can anyone tell me if this is the correct way to bill these codes?
First, are they premalignant lesions? If so, you would want to bill the 17000 and 17003 x 10 (you said 5 on the head and 6 on the foot, that makes 11). The code is not site specific so it does not matter where they were done. Now, if 5 lesions are premalignant and 6 lesions are not, then you would bill 17110, 17000 - 59, and 17000 x 4 - 59. I hope this helps

Cortney Fisher, CPCD
 
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