Coding is never easy and even in a case, which appears simple, when a patient comes for treatment of skin lesions, reporting can be complicated. But determining whether your dermatologist performed a biopsy or destruction and these three steps from our experts will make your job easier:
Step 1: Check the Lesion Method
To distinguish between procedure codes 11100-11101, 17000-17004, and 17110-17111, you should first check your dermatologist’s notes for the method he used.
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Key words: Examine the note to determine whether the physician biopsied or destroyed the lesion. Lesion biopsy indicates the dermatologist performed 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) or +11101 (… each separate/additional lesion [List separately in addition to code for primary procedure]). If he destroyed the lesion, you should code a destruction, such as 17000-17004 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses] …) or 17110-17111 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions …).
Sometimes, however, dermatologists don’t include the procedure information in the chart note.
You may have to let the lesion method drive your biopsy-versus-destruction coding. In this case, knowing which method corresponds to which procedure will clue you in to the proper code.
Watch out: Medicare may deny 17000 with any diagnosis except 702.0 (Actinic keratosis), for medical necessity, warn experts....
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