Key Coding Insights For Skin Conditions And Wounds
- Volume 17 - Issue 10 - October 2004
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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. After 2003, the proper way to code skin lesion excisions is to measure the widest width of the lesion and then add the clear border/margins required on both sides of the lesion. This may affect the eventual CPT billing code you use as this new approach to coding these lesions allows the proper billing of a higher code. For example, if one excises a 1.2 cm lesion with 2 mm margins on both sides, the proper “size” of the lesion is 1.2 cm + .2 cm +. 2 cm. This adds up to a 1.6 cm lesion.
When You Need To Obtain A Biopsy
Diagnosing skin lesions can be difficult as one may often see an unclear clinical picture. In these cases, a biopsy is required. One can bill a biopsy of skin and subcutaneous tissues by using the CPT code series 11100 for a single lesion and adding CPT 11101 for each additional (separate) lesion. Closure of the biopsy is included in the procedure fee allowance. If you perform a shave biopsy in which you essentially remove the entire lesion, use the CPT 11305-11308 code series.
For a biopsy of the toenail/nail unit, one can bill this with the CPT code 11755. This code description includes biopsy of the nail plate, nail bed, nail matrix and adjacent hyponychium, and nail folds.
There is some controversy as to the proper use of this code for a biopsy of the nail itself. One should not use this code when simply clipping a loose or crumbling portion of nail for KOH or DTM testing of the nail.
There may be specific instances when a more definitive diagnosis is necessary and one needs a PAS stain. In these cases, it will be necessary to remove a larger and more proximal piece of nail. Clearly document why such a definitive test is required as opposed to other types of fungal nail testing. Check with the specific insurance company regarding what it requires for documentation of onychomycosis or tinea. Routinely performing nail biopsies as a means of obtaining fungal specimen is of questionable medical necessity and may result in audits.