By Dirk Elston, MD, December 03, 2012
I biopsied and curetted a suspected basal cell carcinoma, but the pathology report indicated that the lesion was simply a benign nevus. Do I bill this as a biopsy, or as destruction of a benign lesion?
It should be reported as a biopsy.
When a suspected basal cell carcinoma is biopsied and curetted, it is appropriate to hold the bill until the pathology report is received. Both the initial size of the lesion and the size of the curettage defect should be recorded in the medical record. If the lesion proves to be a basal cell carcinoma, the definitive procedure was the destruction, which would be appropriately reported using the size of the final curettage defect as the true size of the malignancy. The biopsy is regarded as a component of the destruction and may not be reported separately.
If, on the other hand, the lesion turns out to be benign, the only medically necessary service that was provided is the biopsy. We only report medically necessary services to the payer, so only the biopsy would be reported. [pagebreak]
Destruction refers to the ablation of benign, premalignant, or malignant lesions by any method. This would include curettage, electrosurgery, cryosurgery, or laser or chemical treatment, but does not include removal by means of a blade or surgical scissors.
The destruction codes listed in the Integumentary section of the CPT manual are categorized by benign, premalignant, and malignant lesions, with different codes assigned to each category.
Please note that the injection of local anesthesia is included in the destruction, and may not be reported separately. Biopsy performed immediately prior to the destruction and prior to the receipt of a biopsy report is also considered a component of the destruction and may not be reported separately. Surgical supplies are included in the reimbursement for the procedure and no separate charge is appropriate for these supplies.
Rules for destruction of benign lesions
Codes 17110 and 17111 are used to report the destruction of benign lesions, such as warts, by any of the methods listed in the code descriptors (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettage). For destruction of up to 14 lesions, only code 17110 should be reported. For 15 or more lesions, only code 17111 should be reported. Skin tags and cutaneous vascular proliferative lesions are not reported with codes 17110 and 17111. [pagebreak]
Example 1: I applied cantharidin to seven molluscum contagiosum lesions and reported it using 17110.
Correct: Cantharidin application to molluscum contagiosum lesions is chemosurgical destruction, and should be reported with codes 17110-17111, depending on the number of lesions treated.
Example 2: I froze two warts on the hands and three plantar warts. Do I report 17110 once for each location?
No. 17110 is only reported once for the destruction of up to 14 benign lesions. For the destruction of one to 14 benign lesions, other than skin tags or cutaneous vascular proliferative lesions, use code 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.
Example 3: I electrodessicated a wart that had been refractory to other treatment. I had to inject xylocaine prior to the procedure. Do I report the injection separately?
No. According to the CPT codebook, destruction means ablation by any method, including any required local anesthesia. Any method includes electrosurgery, cryosurgery, laser, and chemical treatment.
Editor’s Note: This is Dr. Elston’s last Cracking the Code. Dermatology World thanks him for two years of great columns and looks forward to his From the President column starting in March. Alexander Miller, MD, the AAD’s current AMA CPT Advisor, will take over this column starting next month.