How To Use CPT Code 10040

CPT 10040 refers to acne surgery, which involves the opening or removal of multiple milia, comedones, cysts, and pustules. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 10040 procedures.

1. What is CPT 10040?

CPT 10040 is a medical procedure code used to describe acne surgery, which involves the opening or removal of multiple milia, comedones, cysts, and pustules. This code is used by medical coders and billers to accurately document and bill for this specific type of acne treatment.

2. 10040 CPT code description

The official description of CPT code 10040 is: “Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)”.

3. Procedure

The 10040 procedure involves the following steps:

1. The patient is appropriately prepared for the procedure.
2. The provider may inject a local anesthesia, such as lidocaine, to numb the area.
3. For smaller, uncomplicated lesions like comedones, the provider may use an extractor or a suction-type instrument to remove them mechanically.
4. For other lesions, the provider may use a fine-tipped needle or pointed blade to open up the lesion and remove the contents.
5. If the lesion is very large, the provider may marsupialize it by opening it up and suturing the edges of the cyst lining to the exterior of the cyst, creating a pocket to allow the cyst to continue to drain.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 10040 services are those with acne lesions such as milia, comedones, cysts, or pustules that require surgical intervention. This may include patients with severe or persistent acne that has not responded to other treatments, or those with large or painful cysts that need to be drained or removed.

5. When to use CPT code 10040

It is appropriate to bill the 10040 CPT code when a provider performs acne surgery on a patient with qualifying circumstances, as described above. The procedure must involve the opening or removal of multiple milia, comedones, cysts, or pustules, and may include marsupialization if necessary.

6. Documentation requirements

To support a claim for CPT 10040, the following information should be documented:

• Patient’s medical history and diagnosis of acne
• Details of the patient’s prior acne treatments and their outcomes
• Physical examination findings, including the location, size, and type of acne lesions
• A clear description of the procedure performed, including the specific techniques used and the number of lesions treated
• Any complications or adverse events that occurred during the procedure
• Post-procedure care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 10040, it is important to follow the specific guidelines and rules set forth by the payer. Some payers may not allow separate billing for the injection of local anesthesia or the anesthetic itself, so it is crucial to verify their preferences before submitting a claim. Additionally, ensure that all required documentation is included to support the claim and avoid potential denials or delays in payment.

8. Historical information

CPT 10040 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 10040

Five similar codes to CPT 10040 and how they differentiate are:

1. CPT 10060: This code is used for incision and drainage of an abscess, which is different from acne surgery.
2. CPT 10061: This code is also used for incision and drainage of an abscess, but it involves more complex or multiple abscesses compared to CPT 10060.
3. CPT 11000: This code is used for debridement of extensive skin and/or subcutaneous tissue, which is a different procedure than acne surgery.
4. CPT 11042: This code is used for debridement of skin, subcutaneous tissue, muscle, and/or fascia, which is a more extensive procedure than acne surgery.
5. CPT 11055: This code is used for the trimming of a benign skin lesion, which is a less invasive procedure than acne surgery.

10. Examples

Here are 10 detailed examples of CPT code 10040 procedures:

1. A patient with multiple inflamed comedones on the forehead undergoes acne surgery using an extractor to remove the lesions.
2. A patient with several large, painful cysts on the cheeks undergoes acne surgery with marsupialization to drain the cysts and promote healing.
3. A patient with a combination of milia and pustules on the chin undergoes acne surgery using a fine-tipped needle to open and remove the lesions.
4. A patient with persistent acne on the back undergoes acne surgery to remove multiple comedones and cysts using a combination of extraction and marsupialization techniques.
5. A patient with severe acne on the chest undergoes acne surgery to remove multiple pustules and cysts using a pointed blade and suturing technique.
6. A patient with a history of unresponsive acne treatments undergoes acne surgery to remove multiple milia and comedones on the nose using an extractor.
7. A patient with large, inflamed cysts on the jawline undergoes acne surgery with marsupialization to drain the cysts and reduce inflammation.
8. A patient with a combination of comedones and pustules on the temples undergoes acne surgery using a fine-tipped needle to open and remove the lesions.
9. A patient with multiple cysts on the neck undergoes acne surgery using a combination of extraction and marsupialization techniques to remove the lesions and promote healing.
10. A patient with severe acne on the shoulders undergoes acne surgery to remove multiple pustules and cysts using a pointed blade and suturing technique.