Electrodessication with curettage (ED&C) Measurement

Question:

Good Afternoon, please clarify how lesions are measured for the destruction of malignant lesion codes 17260-17286. Is the code selection based on the size of the lesion before or after the curettage?

We are unable to find guidance from AMA or CMS. Our provider is stating that it is based on the size after curettage and basing it on this article at this link:
www.hmpgloballearningnetwork.com/site/thederm/site/cathlab/event/size-matters#:~:text=Size After Curettage, but Before,a 1.5 cm/d measurement.

Answer:

For destruction of malignant lesion codes 17260-17286, the code selection is based on the size of the lesion AFTER curettage, but BEFORE electrodesiccation.

Destruction of malignant lesions (CPT codes 17260 to 17286) is selected based on the lesion size after curettage, but before electrodesiccation. This timing is important because:

1. Initial clinical appearance may be misleading - The lesion might appear to be a certain size clinically, but curettage helps visualize the true extent of the malignant tissue.

2. Curettage reveals actual lesion boundaries - After curettage, the physician can better assess the actual diameter of the lesion that needs to be destroyed.

3. Before electrodesiccation - The measurement should be taken after curettage but before the electrodesiccation (destruction) process begins, as the destruction process itself would alter the lesion size.

*This response is based on the best information available as of 11/20/25.

Wound Vac with CPT Code 15002

Question:

I was hoping someone could answer a question for me. My Revenue analyst is telling us to bill a 15002, instead of a 11042 for chronic wound care when we are also doing a wound vac. In my opinion 15002 should not be used we are not prepping for tissue transfer.

Answer:

You're absolutely right to question this. CPT 15002 is specifically for "surgical preparation or creation of recipient site by excision of open wounds" in preparation for skin grafts or flaps. The key word is "preparation" - it's meant for wounds being readied for tissue transfer procedures.

If you're providing chronic wound care with wound vac (NPWT) therapy but not actively preparing for an immediate skin graft or flap, then 15002 is not appropriate.

CPT 11042 (debridement of subcutaneous tissue) is the correct code when you're performing debridement as part of chronic wound management, including when using negative pressure wound therapy.

Here's the distinction:

• 15002 = Debridement with the specific intent and plan to perform skin grafting/flap reconstruction

• 11042-11047 = Debridement for wound care management, infection control, or promoting healing

*This response is based on the best information available as of 11/06/25.

Preventative Skin Check Coding

Question:

Can you clarify visit elements and review of systems are required for a preventative skin check? I have been told a full ROS is required for a preventative skin exam, as well as, medical and family history, lifestyle counseling, and age/gender appropriate screening performed. I believe dermatology to be problem oriented and a skin cancer screening vs preventative has been a huge gray area for me. Can you clarify the difference and requirements to be truly a dermatology preventative visit?

Answer:

The confusion arises because full-body skin cancer screenings in dermatology are rarely actual preventive medicine visits. Dermatology is specialty care, not primary care. Preventive medicine codes are typically reserved for primary care physicians providing comprehensive preventive services not performed in Dermatology, as they would be conducted in primary care. If you're performing a skin exam, you're not meeting the requirements for a preventive medicine visit (which requires multi-system examination and comprehensive counseling beyond just skin).

A dermatology skin cancer screening is appropriately coded as a problem-oriented visit with documentation matching the medical necessity and level of service provided based on either medical decision making or time.

For a routine skin cancer screening in dermatology, you should:

• Code as a problem-oriented visit (most commonly 99203/99213)

• Document risk factors justifying the exam

• Perform a clinically appropriate history and exam

• Document the assessment and plan of care relative to the history and examination

You will only bill a preventive medicine code if you provide comprehensive age-appropriate preventive services as a primary care provider would, which is not the typical dermatology scenario

*This response is based on the best information available as of 10/23/25.

Pyogenic Granuloma

Question:

Hello! Could KZA clarify if the excision of a pyogenic granuloma (lobular capillary hemangioma) would be assigned to a code from the musculoskeletal or integumentary system? We have seen some conflicting information.  

Answer:

Thank you for reaching out to KZA!

The origin of the lesion will direct you to the appropriate code selection.

According to CPT:

• Lesions of cutaneous origin are appropriately reported with the excision of lesion integumentary codes (114xx & 116xx).

• Lesions of non-cutaneous origin are appropriately reported with the excision of tumor codes from the musculoskeletal section of CPT (2xxxx).

Pyogenic granulomas are benign, generally considered of cutaneous origin, and reported with a 114xx benign lesion code. If the documentation is unclear, it is best practice to query the surgeon for clarification.

*This response is based on the best information available as of 10/09/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.

E/M Coding Based on Time

Question:

When choosing the level of E/M we are confused about the History and Exam. If we choose a level of E/M based on time, does this time count toward total time, or is it only time spent on MDM?

Answer:

When choosing a level of E/M based on time, CPT identifies the following activities as those that may contribute to total time on the date of service. Obtaining the history and performing the exam contribute to the total time for code selection. These activities occur on the same day as the actual encounter to contribute to the level of service. The following services must be performed and documented by the practitioner. Ancillary staff time does not count.

Physician/other qualified health care professional time includes the following activities when performed:

• preparing to see the patient (e.g., review of tests);

• obtaining and/or reviewing separately obtained history;

• performing a medically appropriate examination and/or evaluation;

• counseling and educating the patient/family/ caregiver;

• ordering medications, tests, or procedures;

• referring and communicating with other health care professionals (when not separately reported);

• documenting clinical information in the electronic or other health record;

• independently interpreting results (when not separately reported) and communicating results to the patient/family/caregiver; and

• care coordination (when not separately reported).

Source: CPT Assistant April 2022*This response is based on the best information available as of 9/25/25.