Question Excision of Condylomata/skin tag

ELBrock

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The patient presents for complaint of lesions.
The provider documents 1 skin tag on the glute, and 2 skin tag/ or Condylomata on the labia, 1-2 mm, and a vaginal polyp.
If the provider moves forward with excision of all 3 lesions and the polyp removal, what CPT codes should be expected?
I'm thinking of using a skin tag removal CPT, 11200, for the skin tag on the glute, and this will also include the labia lesions if Path returns they are skin tags. However, if the Labial lesions are Condylomata and the provider does document the size of the excisions, then I could use an Excision of Benign lesions CPT? 11420-11426?
If the provider does not document the excision size, would it be appropriate to use the destruction of vulvar lesion CPT, 56501? Or biopsy of vulvar lesion CPT 56605?
For the vaginal polyp removal, would it be appropriate to use CPT 57135, Excision of Vaginal Cyst and Tumor?
Thank you!
 

thomas7331

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It's always challenging, if not impossible, to correctly code without a medical record to look at, and really hard to recommend codes here with this many 'if' statements - I would not try to 'expect' a CPT code until you actually see the record.

To start with, excision and destruction are two distinct techniques for treatment of lesions - these are not interchangeable so you can only use the procedure code that reflects the method that the provider has documented. If the provider performs an excision but does not document lesion size, then you will need to query the provider, not code a destruction instead. In addition, skin tags and benign lesions are very different things, and if there is confusion in the documentation about which it is, this may also require a query.

I would recommend avoiding getting into this kind of a code-guessing game based on what a provider might or might not do, or might or might document, because there really are no right or right answers in coding unless you have a medical record to match those codes to. If you're in the unfortunate position (as some of us often are) of having to preauthorize a procedure before it has been performed and come up with a code without a record, then the best approach is to talk with the provider about their expectations of what they intend and will likely be doing, and try to get the payer to approve any or all of the potential codes that could end up being used based on the information you have.

Sorry not to give more definitive answers, but hope this at least helps some.
 

ELBrock

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It's always challenging, if not impossible, to correctly code without a medical record to look at, and really hard to recommend codes here with this many 'if' statements - I would not try to 'expect' a CPT code until you actually see the record.

To start with, excision and destruction are two distinct techniques for treatment of lesions - these are not interchangeable so you can only use the procedure code that reflects the method that the provider has documented. If the provider performs an excision but does not document lesion size, then you will need to query the provider, not code a destruction instead. In addition, skin tags and benign lesions are very different things, and if there is confusion in the documentation about which it is, this may also require a query.

I would recommend avoiding getting into this kind of a code-guessing game based on what a provider might or might not do, or might or might document, because there really are no right or right answers in coding unless you have a medical record to match those codes to. If you're in the unfortunate position (as some of us often are) of having to preauthorize a procedure before it has been performed and come up with a code without a record, then the best approach is to talk with the provider about their expectations of what they intend and will likely be doing, and try to get the payer to approve any or all of the potential codes that could end up being used based on the information you have.

Sorry not to give more definitive answers, but hope this at least helps some.
Yes, this information was helpful, thank you very much thomas7331! The procedure has not occurred yet, but the patient was asking for the CPT codes to give to her insurance, which put me in a tough position, considering the provider was not sure if the lesions on the Vulva were skin tags or condylomata. We wouldn't know unless a biopsy was done. I had read a procedure for a different patient in the past (that I did not code) for removal of multiple genital warts in the vulvar area. The provider at that time did use a scalpel but did not record the size of each lesion...she had just documented removal by scalpel of 17 lesions measuring between something like 1-3 mm each. I noticed it was coded as destruction, so that's why I was wondering if the provider did not document each lesion/margin sizes, but had multiple removed like that, if utilizing a destruction code was more appropriate than reporting 17 excision codes. I had read in another forum somewhere that many insurances will not pay for excision codes for Condylomata, but only would pay on destruction. Any thoughts on that?
Thank you again!
 

thomas7331

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You may wish to discuss this with your providers for clarification of their thought process when they determine how to treat the patients in these cases. Skin tags and condylomata are two very different conditions that are treated very differently, and in my own experience, I have never seen of a dermatologist simply remove lesions without knowing, or strongly suspecting, what they really are - the physician most likely has confidence in their diagnosis, even if not yet confirmed by a pathology report, and they are treating the lesions according to what they suspect it is.

If they are just removing the lesions with a scalpel, it sounds to me as though they are treating them as skin tags but perhaps sending a sample to pathology just to confirm this. On the other hand, condylomata are normally treated by destruction or ablation of the lesion at the surface - if a scalpel is used, I believe that would likely be to remove excess skin from the surface or to obtain a tissue biopsy, which would be incidental to the destruction. Keep in mind that an excision is defined in CPT as "full-thickness (through the dermis) removal of a lesion, including margins". Just 'removal by scalpel' alone would not qualify as an excision for coding purposes. I have not heard that payers don't reimburse excision of condylomata, but it would not surprise me because that it not the standard treatment for that condition - simply cutting them off would not fully treat the condition.
 
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