APMA News - November/December 2024 - 33

coding update
destruction procedures, not excision procedures.
Full-thickness excisions of benign lesions are represented
by a different set of CPT codes.
When submitting CPT 17110, report one unit of
service for the destruction of anywhere between
and including one to 14 benign lesions. For the destruction
of 15 or more lesions, CPT 17111 should
be used instead. These codes represent various
destruction techniques such as chemosurgery,
cryosurgery, and electrosurgery. Documentation
for this service should include the medical necessity
of the procedure(s), the number and location
of the lesions destroyed, and the method of
destruction used. Removal of benign lesions solely
for cosmetic purposes is typically not a covered
service by third-party payers.
Coding Considerations
Because CPT 17110 represents destruction of a
benign lesion, the ICD-10-CM code used with
this CPT code should represent a benign lesion
and never a malignant lesion. Some third-party
payers issue coverage policies for these destruction
services, and reviewing those policies
is recommended to try to avoid denials, reviews,
and associated issues with reimbursement.
When performing these destruction procedures
as elective procedures for cosmetic purposes for
Medicare beneficiaries, providers may consider
appending the GY Modifier to indicate the service
does not meet the definition of any Medicare
benefit. Under this circumstance, diagnosis code
Z41.1 is a consideration. However, a Medicare
claim for non-covered cosmetic services does not
need to be submitted unless the patient specifically
requests it.
As is the case for all services performed for
Medicare beneficiaries, National Correct Coding
Initiative Procedure-to-Procedure edits should
be referenced when submitting multiple services
performed at the same encounter. Relatedly,
providers should be aware of bundling guidelines
when reporting multiple services performed at the
same encounter.
Modifiers
Below is a list of CPT Modifiers that are often used
with these codes:
Modifier 25: Significant, separately identifiable
evaluation and management service by the same
physician on the same day of the procedure or
other service1
Modifier 24: Unrelated evaluation and management
service by the same physician or other
qualified health-care professional during a postoperative
period1
Modifier 59: Distinct procedural service. This
modifier is used to indicate that a procedure or service
was distinct or independent from other services
performed on the same day.1
Additionally, Modifiers
X[E,S,P,U] may also be considered if applicable.
Modifier 77: Repeat procedure by another physician
or other qualified health-care professional
Take-Home Points
* CPT 17110 and 17111 represent destruction of
benign lesions only.
* CPT 17110 and 17111 represent destruction, not
excision.
* Documentation for destruction of benign lesions
should include the medical necessity of the
service(s) and the number and location of lesions
destroyed.
* For destruction of benign lesions, CPT code selection
does not vary based on size or anatomic
location.
* Only use ICD-10-CM codes that represent
benign lesions when submitting CPT 17110 and
17111.
* Destruction of benign lesions for cosmetic
purposes is not typically a service reimbursed by
third-party payers.
Conclusion
Appropriate use of CPT 17110 and 17111 will protect
reimbursement and decrease the potential for denials.
By appreciating the requirements of CPT code
utilization, thoroughly documenting procedures,
and adhering to third-party payer policies, healthcare
providers can ensure compliance with coding
guidelines while decreasing the potential for delays
and reviews. Staying current with changes to coding
rules and reimbursement policies is essential to
maintaining accurate and compliant practices.
References
1
Current Procedural Terminology (CPT®) is
copyright 1966, 1970, 1973, 1977, 1981, 1983-2023
by the American Medical Association. All rights
reserved. CPT is a registered trademark of the
American Medical Association (AMA).
2 https://www.cms.gov/medicare/payment/
fee-schedules/physician/pfs-relative-value-files
APMA.ORG
apmanews
33
https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files http://www.APMA.ORG
APMA News - November/December 2024

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