You could gain $30 if a shave is also performed.
Treating 17110 as your office’s catch-all skin lesion destruction procedure code could cut $30-$72 from a claim.
As pediatricians look for more ways to maximize services provided in our medical homes, understanding correct coding for skin lesion destruction becomes more important. You could be overlooking providing dermatology procedures that could benefit your bottom line. Here are some to look into -- and how to code them appropriately.
Destruction, which means the ablation of tissues of lesions, is by any method; some methods are code specific, said Robin Linker, CHCA, CPC-I, CPC-H, CCS-P, MCSP, CPC-P, RMC, RMM, CHC, in her "Pediatric Coding Challenges" American Academy of Professional Coders’ presentation. "Often destruction will require more than one code and/or units to report the service."
To tell them apart, try your hand at two cases.
Get to the Bottom of Shaving Lesions
Question 1: A pediatrician destroys 13 molluscum contagiosums on a 5-year-old and shaves a 0.4 cm mole on the patient’s upper arm. Should you use only 17110?
Answer 1: No, thinking you should lump both the shaving and the destructions into one code will cut approximately $30 from the claim. You should report a separate code for the shave.
Shaving of epidermal or dermal lesions, which is literally shaving off a lesion using a sharp instrument, falls under 11300-11313 ("Shaving of Epidermal or Dermal Lesions"), says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.
For the above case, based on the lesion’s location (arm) and size (0.4 cm), you would use 11300 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less), which contains 1.67 transitional non-facility total relative value units (RVUs) using the 2009 Medicare Physician Fee Schedule.
Destruction of benign lesions including molluscum contagiosums counts as 17110-17111 depending on the number of lesions the physician destroys. For destruction of up to 14 lesions, use 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), which contains 2.70 RVUs and pays approximately $97. For destruction of 15 or more lesions, report 17111 (… 15 or more lesions; 3.20 RVUs). Be careful: Do not use 17111 in addition to 17110.
Tip: You may need to use modifier 51 (Multiple procedures) to indicate the destruction is a multiple procedure. Append modifier 51 to the lesser-valued procedure: 11300-51. Complete procedural coding could include 17110, 11300-51. Some insurers may follow Medicare’s multiple procedure reduction and pay 11300 at 50 percent, which would equate to approximately $30.
Stay in 11000s for Skin Tag Removal
Question 2: A parent of a 7-year-old established patient requests skin tag removal during the child’s preventive medicine service. The pediatrician chemically burns off the tag. Will the insurer cover the destruction?
Answer 2: Probably not. And approximately $72 is at stake.
Best bet: Crank out your private payer version of an advance beneficiary notice, "or have a cash policy," suggests Bishop. Often insurers will consider skin tag removal cosmetic and won’t cover the procedure.
When it comes to assigning a number, skin tag removal including destruction puts you back into the 11000 skin series, rather than the 17000 destruction family. CPT’s skin tag numbering system works this way.
• For removal up to and including 15 skin tags, use 11200 (Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions), which has 2.01 RVUs or pays approximately $72.49 using the 2009 conversion factor of 36.0666.
• For each additional set of 10 lesions, or part thereof, report +11201 (… each additional 10 lesions, or part thereof [List separately in addition to code for primary procedure]) (0.47 RVUs).
Don’t miss: To indicate the preventive medicine service is significant and separate from the skin tag removal, append modifier 25 to 99393 (Periodic comprehensive preventive medicine reevaluation and management of an individual … late childhood [age 5 through 11 years]). Code the scenario as 99393-25, 11200. Link V20.2 (Routine infant or child health check) to 99393-25 and 701.9 (Unspecified hypertrophic and atrophic conditions of skin) to 11200.
Question: What is the CPT code for Kinrix?
Answer: You should use new code 90696 (Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated [DTaP-IPV], when administered to children 4 through 6 years of age, for intramuscular use) with V06.3 (Need for prophylactic vaccination with diphtheria-tetanus-pertussis with poliomyelitis [DTp + polio] vaccine). CPT 2009 established the code to report a combination vaccine to protect against pertussis (whooping cough), diphtheria, tetanus, and poliomyelitis (polio) in a single injection.
Kinrix combines the DTaP (diphtheria, tetanus toxoids, and acellular pertussis) and IPV (poliovirus inactivated) vaccines. You previously had no code that represented this combination. Because CPT disallows coding each component of a combination vaccine separately, such as reporting the DTap portion with 90700 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine [DTaP], when administered to individuals younger than 7 years, for intramuscular use) and the IPV component as 90713 (Poliovirus vaccine, inactivated [IPV], for subcutaneous or intramuscular use), you had to use an unlisted procedure code (meaning 90749, Unlisted vaccine/toxoid), per CPT’s "Vaccines, Toxoids" instructions.
Expect staff to administer the vaccine "as a booster dose to healthy children 4 to 6 years of age who completed the recommended immunization schedule for DTaP and poliovirus during their infancy," according to CPT Changes 2009 -- An Insider’s View. Kinrix is indicated for the fifth DTaP and fourth dose IPV in 4 to 6 year olds whose previous DTaP vaccine doses have been with Infanrix (90700, DTaP) and/or Pediarix (90723, Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine inactivated [DTaP-Hep B-IPV], for intramuscular use).
Beware: The vaccine code’s inclusion in CPT 2009 Appendix K, "Product Pending FDA Approval," is a mistake. "Remove 90696 from Appendix K, as this code received FDA approval," according to the AMA’s "Corrections Document -- CPT 2009" www.ama-assn.org/ama1/pub/upload/mm/362/2009cptcorrections-121608.pdf.