Simple Laceration Repair on Skin Right Upper Eyelid

Question:

My physician did a simple laceration repair on the skin right upper eyelid.  What procedure code should I report?  My physician wants to use 67930.

Answer:

For a simple repair of the skin of the eyelid, you should report 12011-12018 based on cm size of the repair.  Report 12011 for a total length of 2.5 cm or less; 12013 for 2.6 cm to 5 cm; 12014 for 5.1 cm to 7.5 cm; 12015 for 7.6 cm to 12.5 cm; 12016 for 12.6 cm to 20 cm; 12017 for 20.1 cm to 30 cm; and 12018 if the total length is greater than 30 cm.  When reporting repair of wounds, the lengths of all repairs are added together and the total is listed for each anatomical site. If the repair involves the lid margin you should report the repair with CPT 67930 (Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness) or 67935 (full thickness).

*This response is based on the best information available as of 11/02/17.

Paramedian Forehead Flap on Previous Mohs Surgery

Question:

My doctor did a division and inset of a paramedian forehead flap on a patient that had Mohs surgery on their nose. Do I code 15620 since the flap was brought from the forehead, or 15630 since the flap was placed on the nose?

Answer:

Good Question:.  If you look at the code descriptors, they state, “Delay of flap or sectioning of flapat…”  This means that the code is chosen for where the flap is inset.  In your case, the flap was inset at the nose.  CPT code 15630 for division and inset at the eyelids,nose, ears, or lips, would be the correct code to report.  Don’t forget also that if repair of the donor site requires skin graft or local flap to repair, it is separately reportable.  Hope this helps.

*This response is based on the best information available as of 07/27/17.

Report actinic keratosis and seborrheic keratosis with 17000-17004 codes?

Question:

If a patient presents to the office with both AKs and SKs. The doctor destroys 11 AKs and 5 SKs. Are these all reported with 17000-17004 codes?

Answer:

No. The actinic keratosis (AKs) are considered premalignant and are reported using codes 17000-17004. The seborrheic keratosis (SKs) are considered benign and are reported using codes 17110-17111. In your case, the following codes should be reported:

17110 Destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

17000-59 Destruction premalignant lesions; first lesion

17003 X 10 Destruction premalignant lesions; second through 14 lesions, each

Make sure that you pay attention to the quantities in the code descriptors so that the proper units are billed. There is a CCI edit between 17110 and 17000 so modifier 59 (or XS) would need to be appended to 17000 to ensure proper adjudication. Hope this helps.

*This response is based on the best information available as of 06/22/17.

Advancement Flap

Question:

My physician excised a malignant skin lesion from the left cheek measuring 2.0 cm. The defect was repaired with a rotational advancement flap with total primary and secondary defect area of 4.75 sq cm. I submitted my claim with CPT 14040 (advancement flap), 12052-51 (repair), and 11642-51 (malignant lesion excision). My claim was denied. Did I code this correctly?

Answer:

You should have reported one CPT code 14040 for the advancement flap which includes the lesion excision and repair. You should resubmit the claim with CPT 14040 and you should get paid.

*This response is based on the best information available as of 03/16/17.

Irrigation and Drainage

Question:

There is some confusion in my office as what is the difference between a simple and complication irrigation and drainage (I&D) of an abscess. Can you help?

Answer:

A simple I&D includes drainage of the pus or purulence from the cyst or abscess and is reported with CPT 10060. The physician leaves the incision open to drain on its own, allowing for healing with normal wound care. A complex I&D includes placement of a drainage tube to allow for continuous drainage or packing to facilitate healing and reported with CPT 10061. In certain cases, tissue excision, primary closure, and/or Z-plasty may be required. Incision and drainage of a blister requires of a “super infection” with pus and abscess formation. CPT 10061 often involves larger abscesses requiring probing to break up loculations and packing to promote ongoing drainage. A loculate region in an organ or tissue, or a loculate structure formed between surfaces of organs or mucous or serous membranes.

*This response is based on the best information available as of 02/02/17.

Intralesional Injections

Question:

Can I Report CPT 11900 x 1 and 11901 for each additional injections for multiple nodular lesions?

Answer:

No. CPT 11900 and 11901 are used to report number of lesions, not number of injections. You would report 11900 for up to and including 7 lesions and 11901 if there are more than 7 lesions. Make sure you document the type of lesions injected (cystic, nodular, keloid, psoriasis, acne, etc.) and location of each individual lesion. You may also separately bill for the medication using an appropriate J code.

*This response is based on the best information available as of 01/05/17.