Destroying benign lesions: Are you getting your money's worth?

September 1, 2009
Inga Ellzey
Inga Ellzey

Inga Ellzey is President/CEO of the Inga Ellzey Practice Group Inc. The nation's foremost expert on dermatology coding, documentation, and reimbursement.

Next to biopsies and the destruction of premalignant lesions, the third most common bread-and-butter service for dermatologists is the destruction of benign lesions (CPT codes 17110 and 17111). In this article, we will discuss the proper use of these codes, rules that govern their use and bundling issues

Key Points

The descriptors

When to use these codes

The benign lesions that are covered by these codes include the following:

The lesions not covered by these codes include:

Some basic rules

CPT codes 17110 and 17111 are "either-or" codes. You use either one or the other, depending on how many lesions are treated. You never use both codes on a single date of service.

The codes are not billed in units. Whichever code is used is billed only at one unit, no matter how many lesions are treated. Each code is paid a flat fee, no matter how many lesions are treated.

When CPT codes 17110 or 17111 are billed for multiple diagnoses, choose one CPT and enter it in block 24E of the claim form. You do not have to break down the number of each type of lesion on the claim form. The exact number of each type of lesion should be documented in the medical record. If an excessively large number of lesions are treated, such as 50 verruca vulgaris, for example, consider billing the service using CPT code 17999-22. Attach an operative note to the claim and send the claim on paper. Do not send electronically.

For retreatment of previously treated lesions, use modifier 58 if retreatment of previously treated lesions occurs during the 10-day postoperative period. No modifier is needed after the 10-day postoperative period expires - unless other surgical services are billed on the same date of service, which may require unbundling modifiers. For treatment of new lesions, use modifier 79 if new lesions are treated during the postoperative period.