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Thread: Need help coding this procedure!!

  1. #1

    Default Need help coding this procedure!!

    Promo: Code Books
    We had three coders look at this documentation. Two of the coders think we need to code 17110 for the removal of the sk's. The other one thinks we should code 11305, 11305x9 mod 51-59. Whats your thought? At the end of document you will see provider chose 17000and 17003. Which all of us agree is not correct.

    CC: skin tag removal.

    History of Present Illness:
    Patient presents for "skin tag" removal. She/he has one SK on face; many on neck and one large one under R arm

    Past Medical History:
    Reviewed history from 05/14/2011 and no changes required:
    Gout
    Sick sinus syndrome

    Past Surgical History:
    Pacemaker placement, revision 2011
    Cholecystectomy

    Social History:
    Reviewed history from 05/14/2011 and no changes required:
    Just moved to assisted living facility

    Risk Factors:

    Tobacco use: never
    Passive smoke exposure: no
    HIV high-risk behavior: no
    Caffeine use: Drinks coffee, tea times per day.
    Alcohol use: no
    Type: No alcohol use.
    Sun Exposure: rarely

    Review of Systems

    Derm
    See HPI

    Vital Signs:

    Patient Profile: 00 Years Old
    Height: 63.5 inches
    Weight: 161.5 pounds
    BMI: 28.26
    BSA: 1.78
    Temp: 96.8 degrees F tympanic
    Pulse rate: 64 / minute
    Pulse rhythm: regular
    BP sitting: 132 / 82 (left arm)
    Cuff size: regular

    Vitals Entered By:
    Physical Exam

    General:
    well developed, well nourished, in no acute distress.
    Skin:
    Multiple SK's on neck; one on face.

    Larges t 2 on neck are about 1 cm; one in axilla is about 3 cm


    Impression & Recommendations:

    Problem # 1: SKIN LESION (ICD-709.9)
    10 small SK's, and 3 large lesions removed with Ellman Unit.

    SK on face frozen.

    The lesions were cleansed with betadine, anesthetized with 2% Lidocaine with epi and removed with the Ellman unit utilizing a loop/shave technique without complications. Hemostasis assured, dressing applied and wound care instructions given.

    Orders:
    Destruction 1st Lesion (CPT-17000)
    Destruction 2-14 Lesions (CPT-17003)
    Excision of Lesion (EXCLES)

  2. #2

    Default skin tag removal

    I think you need to use the 11300 to 11313 for each lesion based on size and location

  3. #3
    Join Date
    Apr 2007
    Location
    Milwaukee WI
    Posts
    4,451

    Default 11200

    11200
    Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
    The physician removes skin tag lesions. Skin tags are common benign tumors found on many body regions, most frequently around the axillae, inguinal area, head, and neck. The physician uses sharp excision with scissors or scalpel, chemical cautery, electrical cautery, ligature strangulation, or any combination of these methods. Report 11200 for up to 15 lesions and 11201 for each additional 10 lesions, or part thereof, beyond the initial 15.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Location
    Fresno Chapter
    Posts
    59

    Default

    Quote Originally Posted by FTessaBartels View Post
    11200
    Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
    The physician removes skin tag lesions. Skin tags are common benign tumors found on many body regions, most frequently around the axillae, inguinal area, head, and neck. The physician uses sharp excision with scissors or scalpel, chemical cautery, electrical cautery, ligature strangulation, or any combination of these methods. Report 11200 for up to 15 lesions and 11201 for each additional 10 lesions, or part thereof, beyond the initial 15.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Hi,
    Your note is saying that the patient had sk's so it would not be appropriate to code 17000,17003, or 11200. Now you could code 11300-11313 for the lesions that have a dimension listed and then 17110 for the remainder of the sk's. But then my question to you is are you coding to your payor that you are billing to?

  5. #5

    Default SK's

    Patient has MDCR so we would code 11305, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59, 11305-51/59. Hope that answers your questions

    Nichole

  6. #6
    Join Date
    Apr 2007
    Location
    Fresno Chapter
    Posts
    59

    Default

    Yes, it does. I would check your LCD for your area. In CA Medicare doesn't cover that code with sk's (dx702.19)

  7. #7

    Default

    Skin:
    Multiple SK's on neck; one on face.

    Larges t 2 on neck are about 1 cm; one in axilla is about 3 cm


    Impression & Recommendations:

    Problem # 1: SKIN LESION (ICD-709.9)
    10 small SK's, and 3 large lesions removed with Ellman Unit.

    SK on face frozen.

    The lesions were cleansed with betadine, anesthetized with 2% Lidocaine with epi and removed with the Ellman unit utilizing a loop/shave technique without complications. Hemostasis assured, dressing applied and wound care instructions given.

    Orders:
    Destruction 1st Lesion (CPT-17000)
    Destruction 2-14 Lesions (CPT-17003)
    Excision of Lesion (EXCLES)

    OK-The documentation of the exam and plan/procedure does not clearly state skin tags nor AKs so I would not code 11200,17000,17003.

    The SK face is frozen =17110

    The rest are by shave and should be 11300 codes...If possible, clarify with the provider. If the intent of the shave is to destroy the SKs then they should code 17110 not 11300 codes.

    Dee
    CPC, CPMA, CPCD
    Dee
    CPC, CPCO, CPMA, CPCD

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