The 17110 CPT code reports the obliteration of one to 14 sores other than skin markers or cutaneous vascular proliferative lesions. The provider thrashes harmless eruptions utilizing chemosurgery, cryosurgery, electro-medical procedure, or others.
To remove benign lesions, the 17110 CPT code must be billed as a single service unit. Likewise, the procedure (CPT 17111) must be coded and billed in one service unit if 15 or 15+ benign lesions are removed.
The lesions in this regard must be benign and should not be any mole or simple vascular lesion.
- POS 2: Home;
- POS 13: Assisted living;
- POS 14: Group home;
- POS 16: Temporary lodging (16); and
- POS 33: Care facility (custodial).
17110 CPT Code Description
The 17110 CPT code is usually reported as a single service unit for benign lesions removal.
As per the description of CPT, it is narrated as the destruction of lesions (that are benign) with the help of laser, electro, chemo or cryosurgery, or surgical curettement.
These lesions are neither skin tags nor proliferative lesions. This CPT also describes the number of lesions destroyed or removed, i.e., from 1 to 14 lesions.
The lesions can be different, such as benign lesions or pre-malignant lesions or lesions with a malignant nature. If the destruction of such types of lesions by any means described above is carried out, one may use the 17110 CPT code.
It is necessary to remove such lesions when they are causing harm to the body. Surgical removal is also recommended for any lesion showing possible malignancy signs.
Suppose there are a more significant number of lesions. In that case, CPT 17111 should be billed in a single service unit to remove more than 15 benign lesions other than cutaneous appendages or cutaneous vascular lesions.
If your physician has destroyed 1 to 14 warts (or mollusks), use the CPT code 17110. However, CPT 17110 is reported only once, even if the doctor destroys 14 lesions.
Billing Guidelines CPT Code 17110
The maximum clinical diameter of the apparent lesion and the margin required for complete excision is used to determine if the 17110 CPT code is billed correctly (lesion diameter + the narrowest margins required equals the expunged diameter).
Based on the physician’s view, the margins relate to the smallest margin needed to remove the lesion adequately.
Before the excision, the lesion and margin are measured. CPT 17000 and CPT 17003 should no longer be used to remove warts or molluscum contagiosum, as these codes now exclude the removal of benign lesions.
Claims for removing benign skin lesions performed only for cosmetic reasons do not need to be submitted to Medicare unless the patient requests an official waiver from Medicare.
If a claim is made, it must be used with the appropriate CPT code (other plastic surgery for unacceptable appearance). ABN can be used for services that may not cover medical or other reasons.
See CMS Publication 10004 (Guidelines for Handling Medicare Claims) for complete instructions.
CPT codes representing easily identifiable surgical procedures contain different services depending on the procedure. The following services are encompassed in addition to the the 17110 CPT code surgery.
- Pre-operative and/or same-day postoperative evaluation and management (E/M) services (including history and physical condition); Local infiltration, metacarpal or metatarsal or digital block, or topical anesthesia
- Abrupt care (postoperative) with a notation of operating histories and discussions through domestic associates and other doctors.
- writing orders
- proper patient evaluation (after anesthesia, recovery area)
- typical postoperative follow-up care
Medical Necessity Of The 17110 CPT Code
The 17110 CPT code is considered medically necessary when ANY of the following conditions are met: e.g., skin tags, nevus [mole], sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion.
- The lesion is accompanied by discharge, bleeding, burning, extreme itching, or pain; or
- Swelling or inflammation accompanied by pus accumulation, or oozing, or maybe edema, or erythema, etc.; or
- The lesion can cause blockage of any opening in the body; or
- Any suspicion of having malignancy (e.g., skin cancer ABCDE changes like asymmetry, border irregularities, color, diameter, evolution, or changes in size, shape, or color) or
- Due to its anatomical location, the lesion is prone to be recurrently traumatized; or
- A previous biopsy suggests or indicates malignancy of the abrasion.
Removal of benign skin lesions, and reported with CPT 17110, and do not meet policy criteria (such as nevus [spots], sebaceous cysts, warts, seborrheic keratosis, or pigmented lesions) are not considered medically necessary.
Some private insurances, e.g., Aetna insurance company, ponders the following as pathologically essential for the 17110 CPT code:
- Acquired congenital nevus (mole);
- cutaneous and subcutaneous neurofibroma;
- dermal fibroma, dermatosis nigricans (skin warts);
- hair follicles (slowly growing hard lumps under the skin (that develop from follicular stromal cells)) removal;
- sebaceous cysts (villi and epidermoid cysts);
- seborrheic keratosis (also called basal cell papilloma;
- senile wart or brown wart);
- other benign skin lesions; or
- needle scraping for sebaceous growth is medically required.
The next criteria:
- A biopsy indicates a precancerous condition (e.g., dysplasia) or malignancy.;
- Lesions may be precancerous (e.g., actinic keratosis (see CPB 0567 Treatment of actinic keratosis), Bowen’s disease, dysplastic lesions, nevus dysplasia, giant congenital melanocytic nevus, black body malignant or vitiligo) or malignant (due to changes in appearance or size, etc., (see note below), especially for individuals or individuals with a family history of melanoma);
- Skin lesions cause symptoms (such as bleeding, burning, and severe itching or irritation).
- The lesion has signs of inflammation (such as swelling, redness, or pus).
- Lesions may be infectious, e.g., wart (verruca Vulgaris).
If Section I does not indicate above, Aetna considers the following cosmetic products:
Clinical suspicion of malignancy is indicated by one of the following: Asymmetry – one half of the mole or lesion does not match the other half;
The edges of moles or foci borders are uneven, torn, and blurred.
The color of the lesion may or may not be exactly similar. It may contain various color shades that may vary from patient to patient;
The diameter (or size) of the lesion may be greater than 6 mm; or the alteration, i.e., maybe in size or maybe in color.
Hyperplasia with needles for;
- dermatosis Nigerians;
- sebaceous cysts, seborrheic keratosis;
- emphysema maculopsis;
- Shibata poikiloderma (sun aging);
- removing dermal fibromas;
- sebaceous hyperplasia; or
- small nevus (mole) or other benign skin lesions.
Medicare does not cover the 17110 CPT code for plastic surgery or the costs associated with such surgery (CMS Publication 10002; Manual of Medicare Benefits Policy, Chapter 16, Section 20).
Including complications from not covered services (CMS Publication IOM 10002 Chapter 16 Section 180).
Skin cosmetic surgery (CPT 17110) is performed, and the beneficiary service provision bears the cost. No cosmetic claims are required unless the patient requests a claim; it must be submitted to the Medicare contractor.
According to the most recent version of Medicare’s Correct Coding Initiative (CCI), some combinations of the four codes are bundled, requiring the use of modifier 59.
There may be some erratic bundles, so keep in mind to go through the CCI edits cautiously before going further. Also, if other surgical procedures are billed on the same DOS (date of service), the CCI tables must be checked as well.
Note: According to the instructions, CCI (Correct Coding Initiative) tables may be subject to change after every 90 days.
Hospital Inpatient Claims
Hospitals must report the patient’s primary diagnosis while coding CPT code 17110 on Locator Form (FL) 67 UB04. The primary diagnosis is the condition established after examination and is responsible for these assumptions.
Hospital enters the ICD 10 CM code for eight additional conditions if they coexist during admission or develop later and affect the length of treatment or hospitalization.
Therefore, the primary diagnosis listed in FL 67 cannot be replicated.
Inpatient claim requires an inpatient diagnosis that must be recorded on FL 69. (For additional guidance, see CMS Publication 10004, Guide to Medicare Claims Processing, Chapter 25, Section 75).
Modifiers For The 177110 CPT Code
The expression of modifier with CPT 17110 signifies that the service accomplished has been altered because of some certain state of affairs.
The modifier also enables healthcare professionals to effectively respond to payment policy requirements set by other institutions, including public and private payers.
Failure to use or inappropriate use of modifiers may result in denial of your entire claim.
There is no charge for assessment and management services provided before or the day before a dermatological procedure to determine whether or not to have a procedure.
Note: Modifier 57 can only be billed with CPT 17110 for major procedures with a total duration of 90 days.
The office procedures related to the dermatology dept are measured as minor, and most of the time, they may have an accompanying global period of 10 days.
If another procedure or office visit occurs within the 10-day global period, the bill may need appropriate modifiers to ensure reimbursement for CPT code 17110.
CPT 17110 requires a 10-day post-surgery period, included in the rate, and modifier 25 with grade and management code. Therefore, assessment and management services are generally not payable on the day of the procedure and in the postoperative period.
Modifier GY must be appended when the provider needs to specify the service that is not covered.
E&M services may be payable on the same day of dermatological operation, but they may be as per rules stated by Medicare.
Medicare pays for the only surgery when it is essential or discretely recognisable health facilities are provided. In addition, it must be distinguished in the form of a record (medical documentation).
Modifier 25 should be added to the appropriate visit code to indicate that the patient’s condition requires a significant and separately identifiable visit in addition to the procedure performed.
17110 CPT Code Reimbursement
Medical records maintained by a physician must document the medical need to remove the lesion to reimburse CPT code 17110.
By Horizon Blue’s refund policy, E&M services billed by the same provider on the same day of skin tag/skin procedure are considered ancillary.
Therefore, the services are not covered separately even with modifier 25 if the diagnosis is submitted for the E&M and skin tag/skin lesion procedure is consistent.
Scar removal has a CPT coding series separate from other benign removals or destruction.
CPT code for skin tags:
- CPT 11200 for 15 lesions; and
- CPT 11201 for additional ten skin tags.
This code is independent of skin tag size, anatomical location, or removal method. Common removal methods may include cryosurgery, shaving techniques, or scissor removal.
CPT code 17110 consists of all consumables used during the procedure. Skin tag cryosurgery falls under this series of CPT codes, so it is not correct to use the 17110 CPT code series.
In addition, many insurance companies may not reimburse CPT 17110 unless there is documentation stating that the skin tags are inflammatory or irritating to the patient.
CPT 11201 may use the quantity modifier if the total number of skin tags removed exceeds 25.
For example, if a provider removes 30 skin tags from a patient, the transmitted CPT code is 11200 (for the first 15 lesions) and CPT 11201 (for the second 15 lesions).
Example Of Denial For CPT Code 17110
Once private insurance, UMR, asked for a few medical documents relating to the procedure after the reimbursement of the claim.
After going through the papers, the insurance denied it by saying it does not seem to fulfill the medical necessity.
We used the primary diagnosis, B07.0. The 17110 CPT code was sent for payment approval, and a detailed note has been sent and a copy of the invoice for review.
Again, UMR responded that the service was not medically necessary. They canceled the tolerance to satisfy the franchise.
The insurance is now asking for the full payment back. After appealing again, they replied that the service provider had supported the reasons for the denial.
17110 CPT Code Example
The patient is visible and is E/M and accepts the surgical procedure from the same visits as the same service work.
E/M was a significant and identifiable estimate, as indicated by other diagnostics than the procedure and (25) modifications.
Procedure 17272 (head, neck, hand, bridge), Damagemignan, Lip 1.1 ~ 2.0 cm, Procedure Code 17262 (Barrel, Cancer, or Bridge) Diameter, Lesion Slide Diameter 1.1 ~ 2.0 cm, Procedure Code 17110, Destruction – Payer Destroy 14 lesion modifications (59) to warn.
Part of the CPT destruction family is destroyed separately from CPT 17272 and CPT 17262.
Finally, in CPT Code 11102, the biopsy prevents the modifier 59 that the service provider does not process the service with other services, and the diagnosis should be supported.
Some of the examples indicating skin lesions of benign nature are:
- sebaceous (epidermoid) cysts
- skin tags
- viral warts
- nevi (moles)
- milia (keratin-filled cysts)
- acquired hyperkeratosis (keratoderma)
The 17110 CPT code (removal of benign skin lesions) is not considered cosmetic if there are any symptoms or signs that require medical treatment, including but not limited to:
- Intense itching
Alteration of appearance physically:
- increase in the number of lesions.
- pigmentary change