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Actinic Keratoses
When using liquid nitrogen to for irritated actinic keratoses what CPT codes should I use? I have been using 17110 and my coder told me that was wrong.
Question:
When using liquid nitrogen to for irritated actinic keratoses what CPT codes should I use? I have been using 17110 and my coder told me that was wrong.
Answer:
You should report 17000 for the first AK (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion) and 17003 foreachlesion treated from 2-14. If you remove 15 or more lesions report 17004 (15 or more lesions). Make certain you document the location of each lesion, method of removal and numbers treated.
*This response is based on the best information available as of 9/3/20.
Soft Tissue Tumor Removal
My physician removed a soft tissue tumor on the patient’s foot measuring 1.2 cm. Documentation indicates subcutaneous. He is coding this as a benign excision and wants to report CPT
Question:
My physician removed a soft tissue tumor on the patient’s foot measuring 1.2 cm. Documentation indicates subcutaneous. He is coding this as a benign excision and wants to report CPT code 11422. Can you tell me if this is correct?
Answer:
The correct CPT code to report is CPT code 28043 (Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm). You would not report a soft tissue tumor excision with the benign skin lesion excision codes.
*This response is based on the best information available as of 7/9/20.
Keloid Scar Destruction
What CPT code should you report for laser removal of a keloid scar? What should be documented in the procedure note?
Question:
What CPT code should you report for laser removal of a keloid scar? What should be documented in the procedure note?
Answer:
You would report 17110. Documentation should always include:
Indications for proceduresRisks/BenefitsDocument location of lesion/keloid destroyedCM size of lesion before removal/destructionMethod of destructionDetail of the procedureAnesthesia/medications
*This response is based on the best information available as of 1/23/20.
Measurements for Excision of Lesion Removal
Our coder sometimes uses measurements listed in the pathology report for lesion excisions, because the measurements are unclear or missing in the procedure note. Is this ok?
Question:
Our coder sometimes uses measurements listed in the pathology report for lesion excisions, because the measurements are unclear or missing in the procedure note. Is this ok?
Answer:
No, for several reasons. Once removed, tissue(s) shrink so don’t depend on the measurements listed in the pathology report as it will most likely be smaller than the actual excision. And It is always necessary to have the measurements of the excision documented in the procedure note. So, if you have Question:s or need documentation clarification, ask your provider for help so he/she can amend the note prior to billing if necessary.
Excision means lesion plus margins (the narrowest margin), not just lesion itself. CPT 2019 gives us several illustrations on page 83 of how to calculate for these codes, so make sure to share this information with your coder and provider.
*This response is based on the best information available as of 12/19/19.
Definition of Simple versus Complicated
What is the definition of simple vs complicated for the I&D codes 10060 versus 10061?
Question:
What is the definition of simple vs complicated for the I&D codes 10060 versus 10061?
Answer:
While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is left open to drain and heal. A complicated I&D 10061 would usually require one or more of the following: multiple incisions, probing to break up loculations, extensive packing, drain placements, and wound closure. If documentation isn’t clear on what exactly was performed, ask the provider for guidance as the reimbursement difference with these codes is fairly significant.
*This response is based on the best information available as of 11/14/19.
What Constitutes the Trunk for Complex Repairs?
CPT question for anatomy: When coding complex repairs CPT 13100-13102 for complex repair of trunk. What body area is included in the “Trunk”. For simple and intermediate repairs the
Question:
CPT question for anatomy: When coding complex repairs CPT 13100-13102 for complex repair of trunk. What body area is included in the “Trunk”. For simple and intermediate repairs the trunk is included with the scalp, extremities, neck, axillae and trunk.
Answer:
You can determine the answer by looking at the code descriptors for the other complex repair anatomic groupings. CPT codes 1312-13122 include the scalp, arms, and/or legs; CPT codes 13131-13133 include the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet. Therefore, 13100-13102 is specifically just the trunk – chest, abdomen, and back.
*This response is based on the best information available as of 10/17/19.
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