To simplify documenting and coding skin procedures, I’ve
developed an encounter form that
highlights the most common scenarios. While using the form, it’s important to
keep the following in mind:
·
The CPT codes for
laceration, excision and shaving are not on the form because of space
limitations. They can be found in the current CPT manual.
·
Excision, shave,
biopsy and destruction of warts are listed in order of declining reimbursement.
So if you code for shaving when you actually excised the lesion, or if you code
for biopsy when you completely excised the lesion, you are penalizing yourself
by not using the correct terminology.
The form can look
a bit daunting at first, but the following reminders should help you put it to
good use:
Laceration
repair. Be sure to
document the laceration’s size, location and the wound closure. Measure the
length of the laceration in centimeters. If multiple lacerations of similar
types are repaired in the same body area, add those lengths together. Closure
is classified as simple, intermediate, complex or reconstructive. Simple
closure is a single-layered closure with no significant debridement.
Intermediate closure involves putting in deep layers, or it can be a single
layer with some debridement required. Complex closure can include extensive
debridement or undermining. Reconstructive closure involves adjacent tissue
transfer or rearrangement (e.g., Z-plasty).
Excision. This procedure involves completely
removing the skin lesion by cutting completely through the dermis
(full-thickness removal). Be careful not to use the term “biopsy” or “punch
biopsy removal” in your documentation or a second party may incorrectly code
the procedure as a biopsy, which would result in less reimbursement. Record the
size of the lesion as the lesion’s maximum diameter plus the sum of the
narrowest margins used to excise the lesion. To assign the proper code, you’ll
need to hold off on billing until you know whether the lesion is benign or
malignant. Excision of a malignant lesion is reimbursed at a higher rate. If
something other than simple closure (e.g., intermediate or complex closure) is
needed to repair the excision, don’t forget to code for closure in addition to
the excision.
Shave. This procedure involves horizontal
cutting to remove a lesion. It is not a full-thickness excision; it does not
penetrate the fat layer. The wound does not need suturing. The lesion’s
location and size needs to be documented before you can assign the proper code.
Biopsy. Bill for this when only part of
the lesion is removed to obtain tissue for pathology. If the entire lesion is
removed, use excision codes instead. Submit 11102 for the first biopsy. For
each separate biopsy after the first one, use add-on code 11103. For example,
if three lesions are biopsied, you would submit codes 11102, 11103 x2 again.
Plantar wart
and keratosis destruction. The treatment of common warts, plantar warts,
actinic keratosis and seborrheic keratosis by most methods (application of
acid, freezing, laser or electrocautery) is covered by “destruction” codes. Use
17000 for destruction of the first lesion. Use add-on code 17003 for each
lesion between two and 14. For example, if you treat four lesions, submit codes
17000, 17003, 17003 and 17003. Many times code 17003 is incorrectly submitted
only once when more than two lesions are removed, resulting in lost
reimbursement. If you remove 15 or more lesions, submit only code 17004.
Flat wart and
molluscum contagiosum destruction. Use codes 17110 and 17111 for treatment
of fl at warts and molluscum by any method. If you treat between one and 14
lesions, submit 17110. If 15 or more lesions are treated, submit only code
17111.
Skin tags. For removal of skin tags by any
method, use codes 11200 and 11201. For the first 15 skin tags removed, use code
11200. For each additional 10 skin tags removed, also report code 11201. For
example, if you removed 35 skin tags, then you would submit codes 11200, 11201
and 11201.
Nails. For trimming of any number of
nondystrophic nails, use code 11719. For debridement of dystrophic nails by any
method, use code 11720 if one to five nails are treated. Submit code 11721 only
if six or more nails are debrided.
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