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Various options exist for treating AKs. Clinicians should select an appropriate treatment based on the patient’s medical history, the lesion’s characteristics, and on the patient’s preference for a specific treatment. Commonly performed treatments for AKs include cryosurgery with liquid nitrogen, topical drug therapy, and curettage. Less commonly performed treatments for AK include dermabrasion, excision, chemical peels, laser therapy, and photodynamic therapy (PDT). An alternative approach to treating AKs is to observe the lesions over time and remove them only if they exhibit specific clinical features suggesting possible transformation to invasive squamous cell carcinoma (SCC). Medicare covers the destruction of actinic keratoses without restrictions based on lesion or patient characteristics. WOUND REPAIR (CLOSURE) - CPT/HCPCS Codes 12001-13300 and G0168 These series of codes are used to describe laceration repair and, in limited situations, closure from a procedure. Wound closure includes repair by sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code. For Medicare claims when a wound is closed solely with tissue adhesive, physicians are instructed to use code G0168, wound closure utilizing tissue adhesive only. Repair (closure) of most surgical wounds is included in the allowance for the primary surgical procedure. However, for certain procedures, wound closure may be separately billed. Undermining the wound margins to permit closure is usually not separately billable using the intermediate or complex wound repair codes. When the wound repair codes 12001-13300 are used for closure of traumatic wounds, the CPT coding guidelines should be followed. Codes 20100-20103 are used to report exploration and repair of trauma wounds requiring Enlargement, extension of dissection (to determine penetration), debridement, removal of foreign body(s), ligation or coagulation of minor subcutaneous and/or muscular blood vessel(s) of the subcutaneous tissue, muscle fascia, and/or muscle, not requiring thoracotomy or laparoscopy. Bundling Of Repair Codes Into Excision Of Benign Lesion Codes Payment for the excision of benign or malignant lesions of skin includes payment for simple repairs. Separate payment for simple repairs (CPT codes 12001-12018) will not be made when reported with the CPT codes for the excision of benign lesions (11400-11446) or the excision of malignant lesions (11600-11646). Medicare Bundling For Medicare claims, payment for the excision of benign lesions with an excised diameter of 0.5 cm or less (CPT 11400, 11420, and 11440) includes payment for simple, intermediate, or complex repairs. In other words, separate payment for simple, intermediate, or complex repairs (CPT 12001-12018) will not be made when reported with CPT codes 11400, 11420, and 11440. Carriers use existing definitions for simple, intermediate, and complex repairs listed in the American Medical Association's Physicians’ Current Procedural Terminology (CPT). For Medicare claims, payment for the excision of a benign lesion with an excised diameter greater than 0.5 cm or the excision of a malignant lesion of any size does not include payment for intermediate or complex repairs. Separate payment for medically necessary intermediate repairs (CPT codes 12031-12057) or medically necessary 5-20 *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.
complex repairs (CPT codes 13100-13152) may be made when reported with CPT codes 11401-11406, 11421-11426, 11441-11446, and 11600-11646. REMOVAL OF CERUMEN In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the American Medical Association (AMA) included the following information in the July 2005 issue of CPT Assistant. The intent of presenting the material is to provide some typical coding scenarios with regard to the appropriate use and application of CPT codes related to earwax removal e.g., 69210. These three scenarios represent frequent patient encounters related to the need for earwax removal: 1. The patient presents to the office for the removal of “earwax” by the nurse via irrigation. 2. The patient presents to the office for the removal of “earwax” by the primary care physician via irrigation or lavage. 3. The patient presents to the office for “earwax” removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction. The AMA states, “A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen.” According to the AAO- HNS, If any one or more of the following are present, cerumen should be considered “impacted” clinically: • Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear conditions. • Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc • Inflammatory considerations: associated with foul odor, infection, or dermatitis • Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instruments requiring physician skills.” The article also includes: Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at a minimum an otoscope and instruments such as wax curettes, or in the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (e.g., cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. 5-21 *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 and 18: preoperative medical evaluation (if
Page 19: The excision of malignant lesion co
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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