Post Operative Infection

Question:

What CPT code would I use for an I&D of a complicated postoperative wound infection?

Answer:

The correct CPT code is 10180 (Incision and drainage, complex postoperative wound infection).

*This response is based on the best information available as of 4/25/24.

Destructions

Question:

What CPT code should I bill for the destruction of seborrheic keratosis? My physician told me to bill 17000 and 17003 for additional destructions.

Answer:

CPT codes 17000 and 17003 are used to report actinic keratosis (AK) destruction, not seborrheic keratosis (SK) destruction(s).  The correct codes are 17110 for up to 14 lesions, and 15 or more lesions are reported with CPT code 17111. Make sure the documentation includes the type of lesion, the number of lesions destroyed and the site of each lesion.

*This response is based on the best information available as of 4/11/24.

Biopsy of Eyelid

Question:

Can I use CPT code 11106 for an incisional biopsy of the eyelid? 

Answer:

An incisional biopsy of the eyelid is not reported with CPT code 11106 but is reported with CPT code 67810 (biopsy of the eyelid).

*This response is based on the best information available as of 3/28/24.

Biopsy on the Same Date as Mohs

Question:

A patient came in for Mohs surgery, but there was no pathology report, so I had to do a biopsy before Mohs surgery.  Can I report the biopsy on the same date as the Mohs surgery?

Answer:

It is standard practice that a confirmed pathology report is available before Mohs surgery. You can bill a biopsy code on the same date as Mohs under the following conditions: 

• There is no previous biopsy on the same lesion within 60 days. 

• No pathology report available. 

• When biopsy and Mohs procedure are on separate sites. 

Ensure that a pathology report that does not exist or cannot be located is well documented.  In addition, You would report a biopsy code 11102, 11104, or 11106, depending on the biopsy method, plus 88331 for the frozen section pathology. Modifier 59 needs to be appended to each code to indicate that the biopsy was distinct and separate.   

*This response is based on the best information available as of 3/14/24.

Repairs following Mohs Surgery

Question:

Our Mohs surgeons will sometimes perform an adjacent tissue transfer or a flap after Mohs surgery.  They want to bill an E/M service with Modifier 57 since they decided to do the flap after Mohs.  I don’t think this is correct.  Can you help clarify?

Answer:

The E/M service should not be reported after Mohs surgery when a decision is made for a repair, flap, or graft.  Even though a flap has a 90-day global period, the surgical decision was made to perform Mohs, the primary procedure.  The intent of the E/M with Modifier 57 for a procedure with a 90 global period is when the initial decision is made to perform the primary procedure.  The repair is secondary; therefore, billing an E/M service is inappropriate.  The discussion and recommendation for the repair is part of the pre-service work for the repair.

*This response is based on the best information available as of 2/29/24.

Seborrheic Keratosis

Question:

What diagnosis code would I use to report a seborrheic keratosis? 

Answer:

Seborrheic Keratoses are benign lesions. The typical diagnosis is L82.1 (other seborrheic keratosis) but if inflamed the correct diagnosis is L82.0 (inflamed seborrheic keratosis).

*This response is based on the best information available as of 2/15/24.