How To Use CPT Code 96904

CPT 96904 describes the procedure for whole body integumentary photography, which is used for monitoring high-risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, as well as patients with a personal or familial history of melanoma. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96904?

CPT 96904 can be used to document the procedure of whole body integumentary photography. This procedure involves using a dermatoscope to examine a patient’s skin and record images of pigmented skin lesions. It helps in distinguishing between malignant and benign skin lesions and aids in the diagnosis of melanoma, dysplastic nevus syndrome, and other skin cancers. The images captured during this procedure can be stored digitally and used for monitoring the progression of the disease.

2. Official Description

The official description of CPT code 96904 is: ‘Whole body integumentary photography, for monitoring of high-risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma.’

3. Procedure

1. The provider applies oil over the area of the skin that exhibits lesions.
2. A glass slide is placed on the skin to eliminate light reflection and make the outer skin layer transparent.
3. The provider uses a dermatoscope, a type of binocular microscope, to examine the skin under moderate magnification.
4. Dermatoscopic images may be recorded and stored for future reference.

4. Qualifying circumstances

CPT 96904 is used for monitoring high-risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, as well as patients with a personal or familial history of melanoma. These patients require regular monitoring to detect any changes in their skin lesions that may indicate the development of melanoma or other skin cancers.

5. When to use CPT code 96904

CPT code 96904 should be used when performing whole body integumentary photography for the monitoring of high-risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma. It is not appropriate to use this code for routine skin examinations or for patients without the specified risk factors.

6. Documentation requirements

To support a claim for CPT 96904, the provider must document the following information:

• Patient’s high-risk status, such as dysplastic nevus syndrome, history of dysplastic nevi, or personal/familial history of melanoma
• Date of the procedure
• Images captured during the procedure
• Any relevant findings or observations
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 96904, ensure that the procedure is performed for the specified qualifying circumstances. It is important to accurately document the patient’s high-risk status and provide the necessary supporting documentation. CPT code 96904 should not be reported with other codes unless there are additional distinct procedures performed during the same encounter.

8. Historical information

CPT 96904 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A patient with dysplastic nevus syndrome undergoes whole body integumentary photography to monitor their skin lesions for any signs of melanoma.
2. A patient with a personal history of melanoma receives regular whole body integumentary photography to detect any new or changing skin lesions.
3. A patient with a familial history of melanoma undergoes whole body integumentary photography as a preventive measure to monitor their skin for any suspicious lesions.
4. A patient with a history of dysplastic nevi receives whole body integumentary photography to monitor their skin for any signs of malignant transformation.
5. A high-risk patient with a personal and familial history of melanoma undergoes whole body integumentary photography to closely monitor their skin for any potential skin cancer development.
6. A patient with dysplastic nevus syndrome receives regular whole body integumentary photography to monitor their skin for any changes that may indicate the development of melanoma.
7. A patient with a history of dysplastic nevi undergoes whole body integumentary photography to monitor their skin for any signs of malignant transformation.
8. A patient with a personal history of melanoma receives whole body integumentary photography to detect any new or changing skin lesions that may indicate a recurrence.
9. A high-risk patient with a familial history of melanoma undergoes whole body integumentary photography to closely monitor their skin for any potential skin cancer development.
10. A patient with dysplastic nevus syndrome receives regular whole body integumentary photography to monitor their skin for any changes that may indicate the development of melanoma.