Wart Destruction with Liquid Nitrogen

Question:

I saw an established patient who I see for evaluation of a wart on the arm. The wart is moderate in severity. I evaluated the wart, performed a skin exam and removed the wart with liquid nitrogen and told the patient to come back PRN. My coder tells me I can only report the wart destruction and not a visit code. Is that correct?

Answer:

It appears the focus of the visit is the removal of the wart (17110). Unless you have a significant separately identifiable E/M service, the E/M service would be inherent to the procedure. Keep in mind the procedure includes pre-service work which is the E/M service. Only the procedure should be reported in the situation you described.

*This response is based on the best information available as of 7/17/25.

Cancer Surveillance E/M

Question:

My physician saw an established patient for follow-up in the office for cancer surveillance. The patient is doing well and no treatment is indicated. In addition, the physician removes a benign lesion on the right anterior neck (1.1 cm) and the patient is being treated for a rash that is acute. The physician recommends cleansers and moisturizers and prescribes a topical steroid. What codes should be billed?

Answer:

An E/M is supported for cancer surveillance and treating the rash. The problems addressed are low complexity (1 acute uncomplicated and 1 stable chronic) with moderate risk (prescription drug management). The level supported is 99213-25. CPT code 11422 is reported for the benign lesion excision on the right anterior neck.

*This response is based on the best information available as of 7/03/25.

Aquaphor and UVB Billing

Question:

Some of our dermatology physicians use Aquaphor as a conductive agent when doing UVB for our psoriasis patients and billing CPT code 96910. We see that Aquaphor is not considered a conductive agent, but we wanted to get your feedback to make sure. Should we use CPT code 96910 or 96912?

Answer:

First, Aquaphor is not a conductive agent.  It is very clear from the CPT guidance that 96910 (photochemotherapy) is reported with tar and ultraviolet B rays (Goeckerman treatment) or petrolatum and ultraviolet B rays. If you use Psolarens, the correct code to report is 96912.   If other substances or no substance is used, you report 96900 (Actinotherapy (ultraviolet light)).  Aquaphor would fall into that category.  

*This response is based on the best information available as of 6/19/25.

Incident-To Billing for Medicare

Question:

I was told for our Medicare patients in order for my PA to report incident-to the physician, that the supervising physician must be in the office.  Is that correct?  We are billing new and established patients under a physician’s NPI number even if there is no physician in the office.

Answer:

To bill Incident-to services a physician must be in the office suite, but it does not need to be the Advanced Practice Provider’s (APPs) supervisor. In addition, you cannot bill incident-to for a new patient when the APP sees them. “Incident To” can only occur for an established patient with an established plan of care originally developed by a physician. If the plan of care changes or the patient has a new or worsening problem, it must be billed under the APP's NPI number. For Medicare, when billing under the APPs NPI number 85% is paid under the Medicare Physician Fee Schedule.

*This response is based on the best information available as of 6/05/25.

Billing for a Simple Repair of the Scalp

Question:

My physician is billing a simple repair of the scalp with CPT code 12001 when he uses steri-strips to do the repair. I don’t believe this is correct. Can we report the use of steri-strips alone to report a simple repair?

Answer:

According to CPT guidelines, repairs are reported when the provider utilizes sutures, staples, or tissue adhesives either singly or in combination with each other, or in combination with adhesive strips. Repairs utilizing adhesive strips alone are not separately reportable. They are part of the E/M service.

*This response is based on the best information available as of 5/22/25.

Need Help Coding Two Dermatology Procedures on the Same Date

Question:

The dermatologist saw a patient in the office yesterday and brought in her pathology report from the family practice doctor. It confirms the cheek lesion is malignant. The physician excised the 1.0 cm cheek lesion and did a simple repair. He also destroyed 3 inflamed seborrheic keratosis with liquid nitrogen on the left hand. What CPT codes should I use?

Answer:

For the 1.0 cm malignant cheek lesion you should report 11641 (excision of malignant skin lesions on the face, ears, eyelids, nose, or lips, with the lesion size ranging from 0.6 to 1.0 centimeters). The simple repair is included in the lesion excision.

For the inflamed SK, you should report 17110 (Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions). You will also need to append Modifier 59 to the destruction code (17110) since it is bundled under the National Correct Coding Initiative (NCCI).

Since the lesion excision is on the cheek and the SKs are on the left hand, the definition of Modifier 59 is met as a separate anatomic area. CPT code 11641 has the higher work RVU’s and should be reported without Modifier 59. CPT 17110 should be reported with Modifier 59.

*This response is based on the best information available as of 5/8/25.