Signing NPP Notes

September 15, 2016 Question: Do I have to sign each of my NP’s notes that are reported incident to? Answer: The guidelines for reviewing and signing NPP documentation are set by each state in its scope of practice regulations. Each practice must research those requirements individually. But as an employer, you are responsible for the…


Three Layer Closure = Complex Repair?

September 1, 2016 Question: Is a 3-layer closure after a malignant skin lesion removal considered a complex repair code (131xx)? Answer: No. Actually, CPT says a “Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents or retention sutures.” The emphasis…


Excision of Scar

August 18, 2016 Question: Patient comes in for what they are calling scar revision and the note states that “standing cutaneous excess of the left abdominal scar” was sharply excised. We are billing with a diagnosis of hypertrophic scar (L91.0) and CPT codes of 11406 (excision of benign lesion) and 12034 (intermediate repair) for the…


Excision of Skin Lesion

August 4, 2016 Question: I heard you say at a course (you were great, by the way. I learned a lot from you!) that we should wait for a pathology report before billing for excision of skin lesions. Please explain why. This may be why I’m not getting paid. Also, when is your next plastic…


Use of Tissue Adhesive for Laceration Repair

July 21, 2016 Question: Does use of a tissue adhesive “count” as a layer for the laceration repair codes? Answer: Actually, yes it does! The CPT guidelines state “Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or…


Adjacent Tissue Transfer (14xxx)

August 21, 2014 Question: I’m reading an operative report and the surgeon says she did “undermining of the incision to close a keloid excision defect.” She wants to use an adjacent tissue transfer code. This documentation doesn’t seem to satisfy the CPT description. What do you think? Answer: We agree with you that the documentation…


Coding for Full-Thickness Skin Grafts

July 24, 2014 Question: Patient has a large skin cancer on the nose. I excised it and repaired the wound with a full thickness skin graft. Donor site for the skin graft was the ear, which was closed by mobilizing skin flaps. We billed 11643 for the excision and 15260 for the graft. Is this…


Excision of Uncertain Behavior Lesion

June 26, 2014 Question: I excised a skin lesion and the pathology came back as a giant pigmented nevus. ICD-9 says this is “uncertain behavior,” 238.2. Which CPT code do I use – malignant (116xx) or benign (114xx)? Answer: Great question! It is most appropriate to use the excision of benign skin lesion CPT code…


Microdermabrasion Coding

May 15, 2014 Question: What is your recommendation for the proper CPT-4 coding for microdermabrasion? Many of my colleagues use the codes for dermabrasion (15780-15783). I have also seen unlisted codes used (17999, 96999). Thank you. Answer: There is not a specific CPT code for “microdermabrasion” because generally this is considered a cosmetic procedure and…


Adjacent Tissue Transfer

April 17, 2014 Question: We billed an excision of malignant lesion CPT code and an adjacent tissue transfer CPT code and only got paid for the lesion removal. How can we get paid for both services? Answer: The excision of a skin lesion code (114xx, 116xx) is included in the adjacent tissue transfer codes (14000-14302)…


Soft Tissue Tumor Codes

February 20, 2014 Question: I removed a lipoma from the chest that was a good size and pretty deep. I’m looking at the excision of benign skin lesion codes (114xx) and they just don’t seem to describe what I did. Please help. Answer: Good thing you asked for advice, because new codes were introduced in…


Excision of a Skin Lesion

January 23, 2014 Question: When coding for excision of a skin lesion (114xx, 116xx), do I use the size on the pathology report to determine the correct CPT code? Answer: The most accurate measurement, according to CPT, is when the lesion has not yet been excised and is still on the patient. The specimen reduces…


Soft Tissue Tumor Codes

Question: I removed a lipoma from the chest that was a good size and pretty deep. I’m looking at the excision of benign skin lesion codes (114xx) and they just don’t seem to describe what I did. Please help. Answer: Good thing you asked for advice because new codes were introduced in 2010 that better…


Skin Lesion Removal and Closure

Question: I have a question on lesion removal and closure coding. If two lesions the same size, same diagnosis (e.g., malignant) and same area (e.g., neck) are removed, is the code used twice or are the sizes added together for one code? I have the same question for a repair- same site (per code description),…


Calculating Size for Codes

Question: I’m new to coding. My doctor and I have a disagreement on how to calculate the size for the adjacent tissue transfer codes (140xxx). The doctor says there was a 16.5 cm by 7 cm wound that he did an adjacent tissue transfer to close. I think I should use a code for a…


Excision of A Sebaceous Cyst

Question: What diagnosis code do we use for a sebaceous cyst – is it a “benign neoplasm”? Answer: Actually, a sebaceous cyst has its own diagnosis code, 706.2, so use of a neoplasm code is not accurate. You’ll use the excision of benign skin lesion CPT code, 114xx, to report the surgical procedure. Remember, many…


Excision of Uncertain Behavior Skin Lesion

Question: If my physician excises a lesion and the pathologist says it is a diagnosis that is considered “uncertain behavior” by ICD-9, do I use the benign excision of skin lesion CPT code or the malignant CPT code when I bill? Answer: Good question! When the diagnosis is categorized with an “uncertain behavior” ICD-9 code,…


ER Consult

Question: When one is called to the ER by the ER physician, and evaluates the patient, a consult code (9924x) is reportable, even though there is a transfer of care, true? Answer: Yes this is a consult (9924x) because you went to the ER and did not know prior to that service that you would…


ER Consult

Question: What if the ER physician sends a patient to me, say for a horrible rash, for evaluation. I see the patient, evaluate the rash, treat it, and send the ER physician a letter. Is this a consult? I’ve been billing these as new patients, but the encounter certainly meets the criteria for a consult….


Excision of Melanoma

Question: I’ve heard differing advice and hope you will clear up something for me. What CPT code do we use for excision of a melanoma? I’ve heard people say to use the excision of skin lesion code, 116xx, and others tell me to use the soft tissue or radical excision of tumor codes such as…


New vs. Established Patient

Question: One of the dermatologists in our community joined our practice and he is now seeing his patients in our office. Are these considered new patients (9920x) when they are seen in our practice? We have to make a new chart and get the patients registered in our computer and that’s a lot of work….


CPT and Diagnosis Codes for a Skin Lesion

Question: A patient was sent to us by another provider who had a biopsy proven pathology report showing a basal cell carcinoma. We removed additional margins and the pathology report came back benign for us. We are confused about whether we should report the CPT and diagnosis codes for a malignant or benign lesion since…


Diagnosis Code for Keratoacanthoma

Question: What diagnosis code and type of excision of lesion CPT code should I use for a keratoacanthoma? Some people say these are benign lesions while I’ve heard others say they are malignant. I’m confused. Answer: Actually the ICD-9-CM coding system states that a keratoacanthoma is coded as 238.2 (Neoplasm of uncertain behavior of other…


Adjacent Tissue Transfer (14xxx)

Question: I understand that 3 of 7 vitals must be noted to qualify for a Skin System comprehensive exam in a level 4 new patient (99204) visit. My question is whether height and weight can be obtained from the patient to meet this criterion or if we have to actually measure the height and weight….


Suture Removal

Question: Is there a CPT code for removing sutures in the clinic after a procedure? Answer: It depends on who put in the sutures. If you put them in after a procedure such as a lesion removal or adjacent tissue transfer, then you cannot charge for removing them as that is part of your global…


Multiple Lesions

Question: The doctor removed 3 lesions: 1) left upper back, 2) right upper back, and 3) right lower back. Each lesion was closed in layers. I got the pathology results back and they all were malignant, with clear margins, so I’m ready to code the case. Do I have to use one malignant skin lesion…


Squamous Cell Carcinoma Excision

Question: My doctor documented the following: Excision of a 1.5 cm squamous cell carcinoma from the neck with wide undermining to advance the tissues and a layered closure. Can we use an adjacent tissue transfer code, 14040, for this procedure? Answer: Absolutely not. “Wide undermining to advance tissues” is not an appropriate use of an…