Comprehensive Dermatology Coding at Your Fingertips

1 10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/121 Comprehensive Dermatology Coding at Your Fingertips1 AAPC Regional ConferenceChicago, ILOctober 2520122 October 25, 201210/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/122 Presenters:Faith McNicholas, CPC, CPCD, PCS, CDC,, ,,Peggy Eiden, CCS-P, CPCD, CPMAA merican Academy of DermatologySchaumburg, Illinois3 Session Objective Overview how and when code use is appropriate Understand code descriptions and guidelines Discuss different types of surgical repair and replacement procedurespp Review 2012 CPT changes to skin repair and replacement surgical codes410/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/123 Overview Significant proportion of invasive procedures involve Integumentary system Due to sophistication, Integumentary procedures often performed in staged fashion Due to changes in technology.

2 medical care should be accurately reflected whencare should be accurately reflected when choosing appropriate CPT code Ensure diagnosis code(s) reflects accurate reason for care/procedure performed56 Effective Jan 1 each yearEffective Oct 1 each year10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/124 OIG 2012 Work Plan Continued from 20119E/M Services: Trends in Coding of Claims9E/M Services: Trends in Coding of Claims9E/M Services During Global Surgery Periods9E/M Services: Potentially Inappropriate Payments New for 20129E/M Services: Use of Modifiers During the Global Surgery Periods7 Audits OIG 40% error rate RAC New pt w/o modifier 25 CERT National CERT Trailblazer error rate at 97% but average is 30%but average is 30%8fcm3 Slide 8fcm3 Peggy, can you also provide some talking points in the note section below so I can understand what exactly this slide refers , 8/9/201210/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/125 Lets talk about dermatological surgical Coding !

3 9 Anatomy Two layers that make up human skin9 Epidermis most superficial layer Composed of four to five layers called stratumstratum Thickness varies based on location of layer1010/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/126 Anatomy, cont d9 Dermis located under epidermis Average thickness is 1mm 2mm Three types of tissues found Contains structures often referred to as skin appendages11 Anatomy, cont d9 Hypodermis used synonymously with subcutaneous and not considered a layer of skin1210/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/127 Documentation ICD-9-CM Codes9 Submit codes withhighest degreeof9 Submit codes with highest degree of accuracy and specificity CPT Codes9 Review codes to ensure diagnosis supportsmedical necessity for the dfdprocedure performed13 Documentation, cont d Lesions9 Documentation must includeDocumentation must include9 Size, location, number of lesions removed If pathology report states lesion of uncertain morphology Choose accurate CPT code that relates to final diagnosis in pathology report1410/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/128 Documentation, cont dGuidelines Review Local Coverage Determination Review Local Coverage Determination (LCD s)

4 And/or medical Policy Guidelines to ensure diagnoses codes support medical necessity for reported procedure Review documentation carefully to diffti t b ttfid hdifferentiate between types of repairs and how they can be reported15 Acne Surgery10040 Acne surgery ( marsupialization, opening or removal of multiple milia, comedones, )9 Maybe considered cosmetic9 Check payer policy99 Pre-authorize procedure9 Obtain patient financial consent 1610/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/129 Acne Surgery17340 Cryotherapy (CO2slush, liquid N2) for acne17360 Chemical exfoliation for acne ( acne paste, acid)9 Maybe considered cosmetic9 Check payer policy9 Check payer policy9 Pre-authorize procedure9 Obtain patient financial consent 17 Incision & Drainage10060 Incision and drainage of abscess ( carbuncle, suppurativehidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia); simple or single10061complicated or multiple1810/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1210 Incision & Removal10120 Incision & removal of foreign body, subcutaneoustissues;simplesubcutaneous tissues.

5 Simple10121 ComplicatedDecember 2006 AMA Comment The choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure Debridement Removal of loose devitalized, necrotic and/or contaminated tissue, foreign bodies and other debris on the wound using mechanical or sharpdebris on the wound using mechanical or sharp technique11042 Subcutaneousfirst 20 cm+11045 Add l 20 cm or part thereof2010/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1211 Skin Tags11200; 1120111200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including15lesionsand including 15 lesions + 11201 each additional 10 lesions, or part thereof(List separately in addition to code for primary procedure (list separately)Guideline:Removal with scissors or any other method ildi ltildt tibitiincluding electrosurgical destruction or combination, including chemical or electrocauterization, with or without local anesthetic.)

6 Check with your payers for coverageIntralesional Injection Codes11900; 1190111900 Injection, intralesional; up to and including 7 lesions11901more than 7 lesions9 Stand alone codes9 Add-on codes When used Complete list found in CPT Appendix D10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1212 Intralesional Injection Codes cont d9 Not used for local anesthetic911900-11901 - Non chemo agents996405-96406 Chemo agents Not reportable separately unless:DiffttDifferent agents9 Report both Procedure & Drug23 Biopsy Codes11100 ; 1110111100 Biopsy of skin, subcutaneous tissue and/or mucous membraneand/or mucous membrane (including simple closure) unless otherwise listed; single lesion+ 11101each separate/additional lesion (List separately in addition to(List separately in addition to code for procedure) 10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1213 Biopsy Codes cont dTechniques:9 ShT h i9 Shave Technique9 Punch Technique9No global days 9 Not bundled withE/M;modifier9 Not bundled with E/M; modifier 25 may be required on E/M when service performed25 Shave Codes11300 - 11313 Shaving of epidermal or dermal lesion, single lesion(location & size)single lesion.)

7 (location & size) 9 Sharp removal by transverse incision or horizontal slicing9 Without full thickness, dermal excision9No sutures required9 Codes based on anatomic location & size10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1214 Other malignant neoplasm of skin Codes114xx; 116xx Full thickness, through dermis removal of lesion If more than one lesion is excised, eachlesion should be reportedlesion Includes simple (non-layered) closure Reported based on 9tishould be reported separately114xx- benign116xx , , 9anatomic area 9size of excised diameterBenign Dx codes , - Malignant Dx codes 10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1215 Example Full thickness removal29 Lesion Removal One removal code per lesion Procedure converted to another Procedure converted to another9report only successful procedure Multiple lesions included in a single removal excision Mltil l idtl Multiple lesions removed separately on same day9use of 59 or quantity billed?

8 3010/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1216 Neoplasm Uncertain/Unspecified - Neoplasm uncertain behavior9 Dysplastic nevusyp9 Keratoacanthoma9 Lesion pending more work-up (histopathology) 239 2-Neoplasm unspecified behavior Neoplasm unspecified behavior9 Based on documentation in the medical recordSigns & Disturbance of skin sensation782 1 Rhthifi Rash, other nonspecific skin Changes in skin texture782 9 Other Other symptoms, skinSigns and symptoms codes acceptable when no definitive diagnosis available to code from10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1217 Site specific Malignant MelanomaMelanoma Malignant Benign Neoplasm9232 face (other).

9 4 scalp, .5 Ca. In upper lower other Neoplasm Instructions Chapter 2 Guidelines: Neoplasm (140-239) code a neoplasm as benign, ()pgin-situ, malignant or uncertain histologicbehavior Section d - Important caveat: Primary malignancy previously excised - once a malignant lesion has been removed with no evidence orlesion has been removed with no evidence or further treatment, the patient s condition will be considered a personal history of a neoplasm or Reg Conf - Chicago, IL - 09/26/1218V codes (supporting ICD-9-CM codes) Personal Hx of Melanomaof Personal Hx of othermalignant neoplasm of of Use of Use of high risk medication35 Site specific biopsy codesYou need to know.

10 11755 - Nail unit (plate, bed, matrix, etc)(p)40490- Lip (vermillion border/mucosal lip)54100-Penis56605-Vulva67810- Eyelid (lid margin, tarsal plate, palpebral conjuctiva)j)69100- Ear, externalReview guidelines on use of these codes10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1219 How to code and report the Integumentary system 37 Destructions 1700x Premalignant1726x Malignant1700xPremalignant1711x Benign9any method9number treated1726xMalignant9based on anatomic location and excised diameter10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1220 Actinic Keratosis: LesionsPremalignant LesionsDx codes: Codes:17110 up to 14Dx: (only)CPT Codes: 170001 lesion+17003 2ndthru 14th1711115+lesions1700415 or more lesions10/10/2012 AAPC Reg Conf - Chicago, IL - 09/26/1221 Photodynamic Therapy (PDT)96567 External application of light to destroy premalignant and/ordestroy premalignant and/or malignant lesions*Reported once per sessionnot per body area treated in a single iit/tvisit/encounterMalignant lesions destruction Destruction, malignant lesions ( laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement of malignant lesions)9 Coded by anatomic location & size 1726x: Trunk, arms, legs 1727x: Scalp, neck, hands, feet, genitalia 1728x.