Highlighting the ins and outs of effective destruction billing

September 1, 2012

Billing CPT codes that start with "17" - the destruction codes - remain a source of confusion for both billers and providers. Destruction means that you are destroying lesions using one of several methods. The most common methods in dermatology include liquid nitrogen, electrodessication and curettage, laser and the use of chemicals. Below is a snapshot summary of the destruction codes.

Key Points

Destruction of actinic keratosis (codes 17000, 17003 and 17004). The only diagnosis code (e.g., ICD-9 code) that can be used for these three codes is 702.0 (actinic keratosis). No other diagnosis code is allowed. CPT code 17000 is only used one time per claim and is always billed at one unit. This code is subject to the multiple surgery rule when billed with other codes on the same date of service with the exception of add-on codes.

CPT code 17003 is a units code and should be billed on one line of the claim form. You can list from two units all the way to 13 units. CPT code 17003 is an add-on code and is NOT subject to the multiple surgery rule.

For Medicare, the code is exempt from the multiple surgery rule. For commercial carriers, it is subject to the multiple surgery reduction rule. All of the above codes have a 10-day postop period.

Destruction of benign lesions (codes 17110, 17111). Codes 17110 and 17111 are used solely for the destruction of benign lesions such as warts, seborrheic keratosis, spider veins, telangiectasia, milia, herpetic lesions and molluscum contagiosum, just to name a few. The codes are used as "either/or" codes. You never bill both on the same claim form. You bill 17110 if you treat up to and including 14 lesions.

Code 17110 is only billed in one unit no matter how many lesions are treated. This is true even if you treat multiple types of lesions. You pick one of the diagnoses and bill the entire code with this one diagnosis, regardless of how many of each type of lesion were treated. Likewise, code 17111 is only billed in one unit no matter how many lesions are treated. This is true even if you treat multiple types of lesions. You pick one of the diagnoses and bill the entire code regardless of how many of each type of lesion were treated.

These codes usually have local carrier decision (LCD) policies that govern under what circumstances these benign lesions can be treated. In other words, the criteria for medical necessity. The LCDs also list the covered diagnoses that are covered and can be used in conjunction with these codes.

Both codes 17110 and 17111 are subject to the multiple surgery reduction rule when billed with other surgical services. Both of these codes have a 10-day postop period.

Destruction of granulation tissue (code 17250). This code is used to treat proud flesh, sinus or fistula granulation tissue. The method of destruction is usually a silver nitrate stick. This code is billed at one unit, and it cannot be used in conjunction with the removal or excision codes for treatment of the same lesion on the same date of service. This code is subject to the multiple surgery reduction rule, and it has 10 postop days.