we have found that there is some confusion as to how to correctly bill these claims. CPT code 17000, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; first lesion, should be billed once for the first such lesion treated, when fourteen or fewer total lesions are removed or destroyed. CPT +17003 is an add-on code specifically for use with the primary CPT code 17000, only. CPT +17003, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; second through the fourteenth lesions, each (list separately in addition to the code for first lesion), should be billed once for each additional lesion treated, up to a total of thirteen times. These two CPT codes, 17000 and 17003, can be thus combined to bill for a total of fourteen such lesions.When billing for the treatment of fifteen or more lesions, CPT code 17004, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions, should be used, and only billed one time for whatever number of lesions are treated beyond fifteen. Whether fifteen or sixty lesions are treated, CPT 17004 should only be billed once for the total service, and should not be combined with CPT 17000 or 17003.For example, for destruction of seven actinic keratoses, the billing would be as follows:17000 (for first lesion)17003 x number of services = 6, for total of seven lesionsIf sixteen lesions were treated, the billing would be:17004 (billed once for 15 or more lesions)Care must be used when selecting the proper CPT code to use, as the 17xxx series codes are not always consistent. For instance, CPT 17110, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of flat warts, molluscum contagiosum, or milia; up to 14 lesions, has no code analogous to 17000 for the first lesion. CPT 17110 is just used once for one to 14 lesions, while CPT 17111, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), flat warts, molluscum contagiosum, or milia; 15 or more lesions, is billed once for 15 or more lesions, not in conjunction with 17110.Some procedure codes for removal or destruction of lesions are billed by size of lesion treated, while others are based on number of lesions treated. The provider should know the descriptors of the procedure codes selected, and is responsible for choosing the appropriate code to reflect what was done. This allows Medicare to pay the correct amount the first time.It has also been noted that often when multiple lesions are removed, they will all have a Pathology evaluation. In cases where benign lesions are removed for the symptomatic criteria listed on the Local Coverage Determination, and are described in the medical record as benign, it does not meet medical necessity criteria for all these to have pathology evaluations. If these are suspicious lesions, the medical necessity criteria are clearly met, but when the description in the chart states that one or more symptomatic benign lesions were removed, pathology examination may not be required and should not be billed to Medicare.
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