pqri measure coding and reporting principles - Indiana Academy of ...

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Note codes 11055-11057 are reported based on the number of lesions involved. Only one code would be used to describe the procedure based on the number of lesions pared or cut. For example, if the physician pared three (3) corns. The physician would report 11056. This code is to be used to report two to four lesions. Removal of Skin Tags Regardless of the method of removal (e.g., scissoring, sharp method, ligature strangulation, electrosurgical destruction, or combination of treatment modalities including chemical or electrocauterization of wound, with or without local anesthesia), codes 11200-11201 are used to report the service. Note these codes are based on the number of skin tags involved. Code 11201 is an add-on procedure that cannot be reported without 11200. Multiple surgical procedures rules do not apply to add-on codes. For example, 20 skin tags are removed. The service should be reported as: 11200 1 unit 11201 1 unit Shaving of Epidermal or Dermal Lesions According to CPT, Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical, or electrocauterization of the wound. The wound does not require suture closure. Physicians sometimes refer to this procedure as a shave biopsy. If the term shave biopsy is used, the coder needs to verify if the entire lesion was shaved (11300-11313) or if a piece of tissue was removed to be sent for pathology (11100 and 11101). The shaving codes (11300-11313) are defined by size and anatomical site. Each lesion removed by shave technique is coded separately. Multiple surgical procedure rules apply to these codes. Excision Benign Lesions Benign excision is defined as full-thickness (through the dermis) removal of lesions of the skin or subcutaneous tissue (e.g., cicatricial, fibrous, inflammatory, congenital, cystic lesions, etc.). Simple closure is included in the excision code; however, intermediate or complex closure may be reported separately for excised diameter greater than 0.5 cm. When both the excision and repair codes are reported, multiple surgical procedure rules apply. The excision of benign lesion codes (11400-11446) are defined by size (including margins) and anatomical site. Each lesion excised is coded separately. Multiple surgical procedure rules apply to these codes. Excision of Malignant Lesions Malignant lesion excision is defined as full-thickness (through the dermis) removal of malignant lesions (pathology report available) of the skin or subcutaneous tissue. Closure by suture is required when using codes 11600-11646. Simple closure is included in the excision code; however, intermediate or complex closure may be reported separately. When both the excision and repair codes are reported, multiple surgical procedure rules apply. 5-18 *All CPT Codes, Descriptions, and Two-Digit Modifiers Only Are Copyright 2006 American Medical Association. GEN 2007 REV 07-01 Copyright 2007 Newby Consulting, Inc.
The excision of malignant lesion codes (11600-11646) are defined by size (including margins) and anatomical site. Each lesion excised is coded separately. Multiple surgical procedure rules apply to these codes. Destruction According to CPT, Destruction means the ablation of benign, premalignant, or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure. Any method includes electrosurgery, cryosurgery, laser, and chemical treatment. Lesions include condylomata, papillomata, molluscum contagiosum, herpetic lesions, warts (i.e., common, plantar, flat), milia, or other benign, premalignant (e.g., actinic keratoses), or malignant lesions. Destruction Premalignant Lesions - Coding Change – Reporting Destruction of Benign or Premalignant Lesions Newby Note: Significant revisions in the descriptions for the following codes require adjustments of billing practices for the destruction of lesions. Be sure to update your superbill/charge ticket to reflect these changes. 17000 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions [Emphasis Added] (e.g., actinic keratosis); first lesion 17003 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions [Emphasis Added] (e.g., actinic keratosis); second through 14 lesions each (List separately in addition to code for first lesion) 17004 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions [Emphasis Added] (e.g., actinic keratosis); 15 or more lesions Please note code 17004 is not an add-on code. If 15 or more lesions are destroyed on the same patient on the same day, only code 17004 is reported (codes 17000 and 17003 are bundled). Destruction Benign Lesions including Flat Wart, Molluscum Contagiosum, or Milia Codes 17110-17111 should be used to report the destruction of benign lesions, flat warts, molluscum contagiosum, or milia. 17110 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), benign lesions [Emphasis Added] other than skin tags or cutaneous vascular lesions; up to 14 lesions 17111 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), benign lesions [Emphasis Added] other than skin tags or cutaneous vascular lesions; 15 or more lesions Destructions Malignant Lesions Codes 17260-17286 are used to report the destruction of malignant lesions (pathology report available). Note codes 17260-17286 are defined by size and anatomical site. Each lesion is coded separately. Multiple surgical procedure rules apply to these codes. ACTINIC KERATOSIS Medicare National Coverage Determinations Manual – Chapter 1, Part 4 - §250.4 - (Rev. 1, 10-01-03) CIM 35-101 Actinic keratoses (AKs), also known as solar keratoses, are common, sun-induced skin lesions that are confined to the epidermis and have the potential to become a skin cancer. 5-19 *All CPT Codes, Descriptions, and Two-Digit Modifiers Only Are Copyright 2006 American Medical Association. GEN 2007 REV 07-01 Copyright 2007 Newby Consulting, Inc.
Page 1 and 2: PQRI MEASURE CODING AND REPORTING P
Page 3 and 4: ! The line item charge should be $0
Page 5 and 6: ICD-9: 250.00-250.93, 648.00-648.04
Page 7 and 8: _____ _____ _____ _____ _____ Beta-
Page 9 and 10: Definition: Pharmacologic Therapy:
Page 11 and 12: Definition: Characterization includ
Page 13 and 14: eport the proper CPT II Category II
Page 15 and 16: • Physicians and qualified nonphy
Page 17: preoperative medical evaluation (if
Page 21 and 22: complex repairs (CPT codes 13100-13
Page 23 and 24: HEMORRHOIDECTOMY BY SIMPLE LIGATURE
Page 25 and 26: Medicare “Incident to Clarificati
Page 27 and 28: service or other face-to-face servi
Page 29 and 30: HOSPITAL OBSERVATION SERVICES - CPT
Page 31 and 32: If the physicians are each responsi
Page 33 and 34: documented. If the time is not docu
Page 35 and 36: Follow-Up Consultation Service Effe
Page 37 and 38: A physician (primary care or specia
Page 39 and 40: typical severity of the problem(s)
Page 41 and 42: Medicare Part B payment policy does
Page 43 and 44: HOME SERVICES - CPT CODES 99341-993
Page 45 and 46: the medical records must clearly do

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