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.