A professional, HIPAA compliant medical coding company in Tulsa, Oklahoma, Outsource Strategies International (OSI) is dedicated to providing accurate medical billing and coding services for diverse medical specialties. Our skilled coding team is experienced in assigning accurate diagnosis codes, procedure codes and modifiers.
In this podcast, Natalie Tornese, one of the senior solution managers of MOS (Managed Outsource Solutions) provides listeners with information about four most common dermatological skin procedures and how to code them using procedure codes (CPT).
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Hello everyone, and welcome to our podcast here. My name is Natalie Tornese, and I am one of the senior solution managers for Outsource Strategies International. I wanted to take this opportunity to go with the four most common dermatological skin procedures and how to code them. I will specifically be addressing excision, biopsy, removal by shade, and the destruction of warts.
First, I’ll talk about excisions. It is important to remember that if any part of the documentation mentions a biopsy, that you do not code this as an excision. Biopsies are always coded different. An excision requires removal of the entire thickness of the dermis through to the subcutaneous tissue.
When coding an excision, there are several factors to take into account regarding the proper course of action. These factors are alluded not only to size, but whether or not the lesion is benign or malignant. Pathology will determine which code set, benign or malignant, is used for proper coding.
A benign lesion is reported using code set 11400-11446, and malignant is 11600-11646. Always use the maximum diameter as well as the sum of the narrowest margin used to excise the lesion. That is very important as well, as this will have a direct impact on whether to code from integumentary or musculoskeletal systems.
Only intermediate and complex closures can be reported separately. Simple closures are always included with the incision code and are not to be recorded separately. Remember that each lesion excision is treated individually, and is always a separate procedure. When coding for multiple lesions, we would add modifier 59 when necessary to avoid any duplication denials. The CPT manual defines modifier 59 as follows:
Distinct procedure or service
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E&M services performed on the same day. Modifier 59 is used to identify procedures and services other than E&M services that are not normally reported together, but are appropriate under the circumstance. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion or separate injury or area of injury, and extensive injuries not ordinarily encountered or performed on the same day by the same individual.
Now let’s talk about biopsies. A biopsy usually means that the provider has only removed a portion of the lesion, tissue or skin for analysis. Taking a portion is not removal. If the entire lesion is removed, you would not use a biopsy code. In these cases, you would choose an excision code.
Biopsies can be removed using several different techniques. Some of these include scissor, shaving with the blade or a specialized instrument, extractions using a punch, and excisions down to the subcutaneous fat with the scalpel. When coding biopsies, you would code the number of lesions biopsied. All first biopsies are coded using code 11100, and each additional biopsy would require code 11101.
Removal by shave is a procedure that involves horizontal cutting to remove growths such as moles and lesions from your skin. Unlike a biopsy, this procedure removes epidural and dermal lesions without a full thickness dermal excision. This includes local anesthesia and chemical or electrocauterization and does not require a suture or closure. Removal by shave is reported using code set 11300-11313.
You need to remember the following details when coding a removal by shave:
- Remember that each shave lesion is reported separately.
- The anatomical occasion and size of the lesion needs to be documented.
- Removed tissue is usually then submitted for pathological exam, which in these cases, is not considered as a separate biopsy procedure.
Wart and keratosis destruction is coded using code 17110, which is destruction of benign lesions other than skin tags or cutaneous vascular lesions. This code covers up to 14 lesions. For 15 or more lesions, you would use the code 17111.
I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.
Thank you for listening!
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.