Lesion destruction

When reading this article, it would be helpful to have your copy of the CPT book for reference. This article is meant as a companion to the codes listed in the book, and isn’t a replacement for your book or electronic access to CPT codes.

CPT describes destruction as “destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia and not usually requiring closure.” The services are now defined by the type of lesion that is destroyed. CPT notes that any method includes laser surgery, electrosurgery, cryosurgery, chemosurgery and surgical curettement. Also, anesthesia for these services provided by the physician/PA/NP who performs them may not be billed separately.

These codes have a ten-day global period and are considered minor procedures.

Let’s start with skin tags. There are two codes for the destruction of skin tags. 11200 is used for removal of skin tags up to and including 15 lesions, with an add-on code 11201 for each additional 10 lesions or part thereof. The method of the destruction doesn’t affect the code selection. If 1 to 15 skin tags are removed, report 11200 with one unit. If 16 to 25 skin tags are removed report 11200 with one unit and 11201 with one unit –not an additional unit for each skin tag. The CPT code description says each additional 10 lesions, not each additional lesion. That is why the add-on code is reported only once. Use ICD-10 code L91.8 for skin tags. Before you remove skin tags, warn the patient that the insurance company may consider it cosmetic, and may not pay for the service based on medical necessity.

The destruction of premalignant lesions, i.e, actinic keratoses are reported with codes 17000, 17003, and 17004. 17000 is reported for the destruction of a single lesion. Each additional lesion is reported with an add-on code 17003. If four AKs are are destroyed, Report 17000 one unit and report 17003 three units. Use 17003 for the second through the 14th lesion. If 15 lesions are destroyed, use code 17004 with one unit. The ICD-10 code for actinic keratosis is L57.0.

17110 is the code to use for destroying benign lesions such as warts or seborrheic keratoses. The definition of the code specifically states to use this for benign lesions other than skin tags or cutaneous vascular proliferative lesions. Code 17110 is reported once if 1 to 14 lesions are destroyed. If 15 or more lesions are destroyed, use 17111. For common warts, use B07.8, other viral warts. There are two codes in the category L82 for SKs.

In the editorial comments under the heading “destruction” and before code 17000 there is an instruction on reporting destruction of lesions in specific anatomic sites. Specifically, CPT instructs us to use other codes for lesions destruction of the mouth, eyelid, conjunctiva, penis, anus, vulva and vagina.

40820—Mouth

46900—46917—Anus Code selection varies by method, and if simple or extensive

46924–Anus

54050—54057—Penis Code selection varies by method, and if simple or extensive

54065–Penis

56501—Vulva Code selection depends on simple or extensive

56515—Vulva

57061—Vagina Code selection depends on simple or extensive

57065–Vagina

67850—Eyelid

68135–Conjunctivae

If a physician destroys a lesion on the mouth, eyelid, or conjunctiva, use a code from the organ system to which they relate. Those codes are listed above. For destruction of the lesion of the anus or the penis the codes are defined as simple or extensive. If the destruction is simple, the method of the destruction determines the code. For lesions of the vulva or vagina, code selection depends on whether the destruction is simple or extensive.

There is also a series of codes for destruction of malignant lesions using any method. These codes are defined by location and the lesion diameter. There is one set of codes for trunk arms and legs (17260—17266). There is a second set of codes for lesions on the scalp, back, hands, feet and genitalia (17270—17276). And there is a third set of codes for lesions on the face, ears, eyelids, nose, lips, and mucous membranes (17280—17286). For these codes we are measuring the diameter of the lesion to select the code, after determining the correct code set by body area. The distinctions are.5 cm or less, .6 cm to 1 cm, 1.1 to 2 cm, 2.1 to 3 cm, 3.1 to 4 cm, or a lesion diameter of over 4 cm.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s