Cryosurgery (liquid nitrogen) is a bread-and-butter dermatology procedure, but it's often under-billed. Using the wrong code for the *number* of lesions is the most common error. The codes for benign/premalignant lesions (like actinic keratoses) are 17000, 17003, and 17004.
Benign Lesion Destruction (17000-17004)
CPT 17000 (1 Lesion):
- Use this code for the first premalignant lesion (e.g., Actinic Keratosis).
- This is the base code for the service.
CPT +17003 (2-14 Lesions):
- This is an add-on code. You must bill it per lesion for lesions 2 through 14.
- Example (3 lesions): Bill 17000 (x1 unit) and +17003 (x2 units).
CPT 17004 (15+ Lesions):
- This is a standalone code for destroying 15 or more lesions.
- Do *not* bill 17000 or 17003 with it. Just bill 17004 (x1 unit).
Benign vs. Malignant vs. Skin Tags
- Benign/Premalignant (17000-17004): Use for premalignant lesions like Actinic Keratosis (AK) or benign lesions like seborrheic keratosis or warts (17110/17111). Correction: 17000-17004 are for premalignant (AKs). 17110/17111 are for benign (warts, SKs).
- Revised Point: Use 17000-17004 for premalignant lesions (Actinic Keratosis). Use 17110 (up to 14) and 17111 (15+) for benign lesions like warts or seborrheic keratoses.
- Malignant (17260-17286): If you are treating a malignant lesion (e.g., SCC in situ) with cryosurgery, you must use the malignant destruction codes.
- Skin Tags (11200-11201): Do not use 17000 for skin tags. They have their own codes (11200 for up to 15, +11201 for each additional 10).
The Common Billing Error
"The biggest mistake is billing 17000 (x1) and 17003 (x1) for 10 lesions. CPT 17003 is a 'per-lesion' code. For 10 lesions, you must bill 17000 (x1 unit) and +17003 (x9 units). Billing it once means you only get paid for 2 lesions instead of 10."
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