Key Coding Insights For Skin Conditions And Wounds

By Anthony Poggio, DPM

Given the vast array of dermatological conditions and wounds that we see in our practices, having a strong understanding of commonly used codes for these conditions is essential but not always simple. With this in mind, let’s take a closer look at coding for both common skin conditions such as verrucae and benign skin lesions, as well as coding tips for I&D procedures and wound closure. Standard billing protocols apply for selecting the appropriate E/M level for services for dermatological conditions. Similarly, protocols for billing E/M services with procedures performed on the same day as the E/M service and the use of clarifying modifiers apply. Charting for dermatological lesions should include the location and number of lesions. The size of the lesion is very important in selecting the appropriate CPT code within a code series. Many skin lesions require multiple treatment sessions or modalities. Therefore, documenting the status of the lesion (healing, not healing, change in appearance, etc.) is important to justify your billing. Describing the lesion is important not only from a billing perspective but for medical-legal reasons as well, especially if there is any suspicion of a malignant skin cancer. Keep in mind that it is very common for several dermatological lesions to be present, even in a relatively small area as the foot. One can group the coding for multiple lesions within a code series or bill them as individual lesions. Using -51 modifiers to designate multiple lesions may be required. Also consider the use of T digital modifiers, RT/LT or –59 modifiers to further clarify your billing per insurance company guidelines. Skin closure of wounds is often incorporated as part of a long-term treatment plan or as a “staged” procedure. Consider the use of modifier –58 in this case. What You Should Know About Coding For Verrucae There are varied treatments for verrucae. If the patient is on a home treatment regimen, then E/M services may be payable to monitor the treatment course. Applying a home treatment medication in the office is not payable separately from the E/M service. When it comes to employing office-based medications (such as monochloracetic acid, canthrone, etc.), a CO2 laser and cryosurgery, these modalities fall under the “destruction” classification and are properly coded with the 17000 series codes. Such treatments are based upon the specific number of lesions you treat. If you treat a single lesion, use CPT 17000. If you treat more than two lesions, use both CPT 17000 and CPT 17003 codes. If you are dealing with more than 15 lesions, use only CPT 17004. Keep in mind that any local debridement of previously treated tissue would be included in the E/M or destruction procedure performed on that day. There is no extra allowance for use of the laser machine. Blunt curettage is another treatment option for verrucae. This requires local anesthesia and blunt enucleating through the skin layers but not past the basement membrane. Usually, no suturing is required. Since there is no potential for closing such a wound, using the CPT 11420 series for excision of a benign lesion is not appropriate. It is best to code the blunt curettage treatment option with the 17000 codes. Coding Tips For Skin Lesions Treatment of benign and malignant skin lesions can include chemosurgery, laser surgery, cryosurgery and curettage. Since no specimen may be available after the procedure, one should clearly document the appearance of the lesion or biopsy prior to destruction. As with verrucae, use CPT code series 17000-17004 for benign lesions. For the destruction of malignant lesions, use CPT code series 17271-17274. Coding for a malignant lesion is based upon the size of the lesion and each lesion you treat is billed individually. For destruction of benign lesions, coding is based upon the total number of lesions. It is best to use the code series CPT 1142X and CPT 1162X when it comes to the respective coding for the excision of benign or malignant foot skin lesions. If you are unsure whether the lesion is benign or malignant, it is advisable to wait for the pathology report before submitting a claim rather than submitting a corrected claim later. Selecting the proper code is based upon the size of the lesion. In the past, one would measure the widest margin of the lesion and use the appropriate code based upon that measurement.

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