pqri measure coding and reporting principles - Indiana Academy of ...
pqri measure coding and reporting principles - Indiana Academy of ...
pqri measure coding and reporting principles - Indiana Academy of ...
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The excision <strong>of</strong> malignant lesion codes (11600-11646) are defined by size (including margins) <strong>and</strong><br />
anatomical site. Each lesion excised is coded separately. Multiple surgical procedure rules apply to these<br />
codes.<br />
Destruction<br />
According to CPT, Destruction means the ablation <strong>of</strong> benign, premalignant, or malignant tissues by any<br />
method, with or without curettement, including local anesthesia, <strong>and</strong> not usually requiring closure.<br />
Any method includes electrosurgery, cryosurgery, laser, <strong>and</strong> chemical treatment. Lesions include<br />
condylomata, papillomata, molluscum contagiosum, herpetic lesions, warts (i.e., common, plantar, flat),<br />
milia, or other benign, premalignant (e.g., actinic keratoses), or malignant lesions.<br />
Destruction Premalignant Lesions - Coding Change – Reporting Destruction <strong>of</strong> Benign or Premalignant<br />
Lesions<br />
Newby Note: Significant revisions in the descriptions for the following codes require<br />
adjustments <strong>of</strong> billing practices for the destruction <strong>of</strong> lesions. Be sure to update your<br />
superbill/charge ticket to reflect these changes.<br />
17000 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),<br />
premalignant lesions [Emphasis Added] (e.g., actinic keratosis); first lesion<br />
17003 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),<br />
premalignant lesions [Emphasis Added] (e.g., actinic keratosis); second through 14 lesions each<br />
(List separately in addition to code for first lesion)<br />
17004 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),<br />
premalignant lesions [Emphasis Added] (e.g., actinic keratosis); 15 or more lesions<br />
Please note code 17004 is not an add-on code. If 15 or more lesions are destroyed on the same patient on<br />
the same day, only code 17004 is reported (codes 17000 <strong>and</strong> 17003 are bundled).<br />
Destruction Benign Lesions including Flat Wart, Molluscum Contagiosum, or Milia<br />
Codes 17110-17111 should be used to report the destruction <strong>of</strong> benign lesions, flat warts, molluscum<br />
contagiosum, or milia.<br />
17110 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),<br />
benign lesions [Emphasis Added] other than skin tags or cutaneous vascular lesions; up to 14<br />
lesions<br />
17111 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),<br />
benign lesions [Emphasis Added] other than skin tags or cutaneous vascular lesions; 15 or more<br />
lesions<br />
Destructions Malignant Lesions<br />
Codes 17260-17286 are used to report the destruction <strong>of</strong> malignant lesions (pathology report available).<br />
Note codes 17260-17286 are defined by size <strong>and</strong> anatomical site. Each lesion is coded separately.<br />
Multiple surgical procedure rules apply to these codes.<br />
ACTINIC KERATOSIS<br />
Medicare National Coverage Determinations Manual – Chapter 1, Part 4 - §250.4 - (Rev. 1, 10-01-03)<br />
CIM 35-101<br />
Actinic keratoses (AKs), also known as solar keratoses, are common, sun-induced skin lesions that are<br />
confined to the epidermis <strong>and</strong> have the potential to become a skin cancer.<br />
5-19<br />
*All CPT Codes, Descriptions, <strong>and</strong> Two-Digit Modifiers<br />
Only Are Copyright 2006 American Medical Association. GEN 2007 REV 07-01<br />
Copyright 2007 Newby Consulting, Inc.