Check Destruction Coding Method
To combat this economic downturn Dermatologists must be keenly aware of how they are coding and if they are leaving money on the table. Treating 17110 as your practices catch-all skin lesion destruction procedure code could cut $30-$72 from a claim-but there is an easy way to avoid this trap.
“Destruction” is a broad term that means ablation of tissues or lesions. The term encompasses any method such as; scrapping, burning, chemical, laser, etc., but some methods are code specific. Understanding how to correctly code for skin lesion destruction becomes more important. Double check whether your dermatologist is providing other services that could benefit your bottom line, and know how to code accordingly.
Get to the bottom of Shaving Lesions
Question: A dermatologist destroys 13 molluscum contagiosums on a patient and shaves a 0.4 cm mole on the patient’s upper arm. Should you use only 17110?
Answer: No, thinking you should lump both the shaving and the destruction into one code will cut approximately $30 from the claim. You should report a separate code for the shave.
Shaving of epidermal or dermal lesions, which is literally shaving off a lesion using a sharp instrument, falls under 11300-11313 Shaving of Epidermal or Dermal Lesions.
For the above case, based on the lesions location (arm) and size (0.4cm), you would use 11300 (Shaving of Epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0,5cm or less), which contains 1.67 transistional non-facility total relative value units (RVUs) using the 2009 Medicare Physician Fee Schedule.
Destruction of benign lesions including molluscum contagiosums falls under codes 17110-17111, depending on the number of lesions the physician destroys. For destruction of up to 14 lesions use code 17110(Destruction of benign lesions, up to 14 lesions, 2.7 RVUs) For destruction of 15 or more use code 17111 ( destruction of 15 or more benign lesions, 3.2 RVUs).
Be careful not to use both codes, 1711 in addition to 17110. You cannot bill for both of these codes at the same time. You can repeat each code based on the number of lesions but cannot bill both of them. 30 lesions would be 17111 x2 for 25 lesions you would just bill 17111.
You might need to use modifier 51 to indicate the destruction is a multiple procedure. If so, append the modifier to the lesser-valued procedure; in this case that would be the 11300-51. Complete procedural coding could include 17110 and 11300-51. Some insurers may follow Medicare’s multiple procedure reduction rule and pay 11300 at 50%, which would equate to approximately $30.00.
« Gross and Net Collection Ratio | Home | Florida 2009 Medicare Fee Schedule »
Comments
I appreciate the information on Dermatology coding. This information has helped my practice capture lost revenue and increase collections.
How many biopsies should my physicians do per visit? Is there a rule limiting the number?
Limiting the number of biopsies per visit depends on your patient population, practice wait time, and liability issues. For example if you can schedule a patient for multiple visits because you are slow and the patient does not have to take 5 days off of work(retired), then that is the best scenario. Most of the working class would rather have everything done at once but this is not feasible from a liability and patient safety standpoint when more than 3 biopsies are needed. It is good when you are able to try to limit your physicians to 2-3 biopsies per visit. This is what we do in our offices and it works well. They do a few biopsies and if there are still more questionable lesions then the provider will biopsy those when the patient comes back for their biopsy results. You have to remember that the more biopsies performed at one visit means the more your medical assistants have to keep track of and mistakes can be made easily if the provider is doing 10 biopsies in different locations and trying to rush through them. If the MA mislabels a specimen, it is a wrong site surgery case waiting to happen.
As far as reimbursement, after the first biopsy it really doesn’t matter because everything after that point is reduced pretty substantially depending on the multiple procedure rules of your particular carrier. For reimbursement, it is good to mix in a shave biopsy(when applicable)when multiple biopsies needed.
Leave a Comment