Coding Skin procedures

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.