I operate a national coding question fax hotline service that is in place for my subscribers to contact me all through the term of their subscription and ask me any coding questions or questions related to billing. I have been doing this for about 15 years now.
Yet, during all of this time, I have never received more faxes in the beginning of the year than I have the first 2 weeks of 2007. I’ve received more during this time than I usually get in 2 months!
I have virtually been spending 2 to 4 hours of each working day answering these faxes. (Believe me, this is not a solicitation for more business. I am trying to cut back on my workload — not trying to generate more activity!)
My point is that the year 2007 is an unprecedented year with respect to the changes that will affect dermatologists. For example, the following changes have occurred:
• There are five new CPT codes for Mohs.
• The multiple surgery reduction rule now applies to the Mohs codes.
• New descriptors for CPT codes 17000, 17003, 17004, 17110, and 17111 were introduced.
• The destruction codes for benign and premalignant lesions seem to be confusing everyone. Most confusing is trying to figure out which codes are bundled and which are not and, if they are bundled, which code gets modifier 59.
It gets even worse. This change alone has generated a slew of questions, such as the following:
• What if the dermatologist does a destruction of a malignant lesion on the same date of service that a wart and some actinic keratoses are destroyed?
• Is modifier 59 required? If so, where?
• Will the services be subject to the multiple surgery reduction rule and, if so, which services will be reduced?
• What will happen if you use modifier 59 when it is not needed?
The questions are endless. No matter how often I explain the changes, whether in my newsletters, in faxes, or in journal articles, the questions keep pouring in and more confusion ensues.
That leads me to this month’s column. Here, I’ll try to answer some of the more interesting questions I have received as well as the ones that seem to plague everyone. Here it goes! I hope this helps.
Q: My patient was in a postoperative period (let’s say a 90-day global). The patient returned after 2 months, at which time I treated the following lesions (all by destruction): two actinic keratoses, 15 warts, and one malignant lesion. I billed the following CPT codes with the following modifiers:
17000 -79
17003 -79
17111 -79
17263-59 -79.
Did I use modifier 59 correctly? Which services will be reduced by the insurance carrier?
A: First, the fact that you asked me if you used the modifier 59 correctly lets me know that you do not have the current version of Medicare’s Correct Coding Initiative (CCI) at your fingertips. This is an absolute must. There is no way you can guess the combinations in Version 13.0 (which became effective Jan. 1, 2007). The bundles are so crazy and make no sense whatsoever.
Guessing will only result in your office’s receiving excessive denials. Appeals will be difficult to reverse.
Based on the new updates in the Medicare CCI edits, if you append modifier 59 to a CPT code where it is not needed, you will get a denial because the computer will be looking for the other code that you are trying to unbundle it with (e.g., the other part of the pair). For example, if you bill CPT codes 11642 and 13132 and put modifier 59 on either of the two codes (none are needed, by the way), the code with modifier 59 will be denied because it doesn’t match up to any of the pair combinations in the CCI.
Look up all of the codes you are billing because they come up in pairs. Always look up all combinations to see if any of the two or more surgical services you plan to bill are bundled.
With respect to your question, you made several mistakes. First, the postoperative modifier should always appear first, if more than one modifier is required on the claim. The modifier sequence should be -79 -59, not -59 -79. Secondly, modifier 59 should be appended to CPT code 17111, not 17263. For example:
• 17000 -79
• 17003 -79
• 17111 -79 -59
• 17263 -79.
If you look up CPT code 17110 in the CCI, it is not bundled with CPT code 17263. But if you look up CPT code 17000, it is bundled with CPT code 17111; hence the modifier goes on code 17111.
To show you how absolutely nonsensical the combinations are in Version 13.0 of the CCI, here are a few more examples. See if you can guess where modifier 59 should go. Don’t look at the answers below until you have put modifier 59 on the following eight sets of CPT codes.
I wouldn’t guess because there is no rhyme or reason for the combinations. It is really difficult.
a.17000, 17003, 17262
b.17000, 17110
c. 17000, 17111
d. 17004, 17111
e. 17000, 17262, 17111
f. 17000, 17110, 17264
g. 17004,17262, 17110
h. 17004, 17282
The answers are as follows: (a) none needed; (b) none needed; (c) 17111 -59; (d) 17004 -59; (e) 17262 -59; (f) none needed; (g) 17262 -59 and (h) 17004 -59.
So how did you do? I bet most of you got at least half or more incorrect (unless you used the most recent version of the CCI).
Keep in mind that every time you put the modifier where it was not needed that CPT code will be denied. In addition, the CPT code that did not get modifier 59 when it was needed will also be denied.
The only solution is getting a subscription to the CCI. It is published and updated quarterly by the National Technical Information Services (NTIS). Inga Ellzey Practice Group has several products that make it easy to check your bundling tables in the CCI, or you can obtain the list directly from CMS (although the files are not organized or easy to decipher). You will just receive the raw data files.
No matter where you purchase the CCI, you have to get a yearly subscription so you can always have the most current version at your finger tips.
Now with respect to the multiple surgery reductions, in your example and mine, all the codes are subject to reduction rules except CPT code 17003. For Medicare claims, CPT code 17004 is also exempt from reductions. I’ll show you at what rate the above examples would be paid based on 2007 RVUs.
• 17000 — 50%
• 17003 — 100%
• 17111 — 50%
• 17263 — 100%
Non-Medicare
a. 17000 — 50%, 17003 — 100%
17262 — 100%
b. 17000 — 50%, 17110 — 100%
c. 17000 — 50%, 17111 — 100%
d. 17004 — 100%, 17111 — 50%
e. 17000 — 50%, 17262 — 100%
17111 — 50%
f. 17000 — 50%, 17110 — 50%,
17264 — 100%
g. 17004 — 100%, 17262 — 50%,
17110 —50%
h. 17004 — 50%, 17282 — 100%.
Medicare
All reductions are the same, except the following:
d. 17004 — 100%, 17111 — 100%
g. 17004 — 100%, 17262 — 100%, 17110 — 50%
h. 17004 — 100%, 17282 — 100%.
Q: I billed CPT codes 11100 and 67810 to Medicare. I put modifier 59 on CPT code 11100, and it was denied. Although I appealed the claim with notes, the insurer still upheld its original denial. Why was this not correctly paid?
A: This is another example of where you put modifier 59 when none was needed. The denial was caused by improper use of modifier 59. You won’t get the claim denial reversed with just notes. You’ll have to convince the carrier (good luck) to remove the modifier from the claim.
Q: If a patient comes into the office and has condyloma cryosurgically destroyed in the groin area as well as on the penis, can we charge using CPT codes 17110 and 54056 since they are from different anatomic sites? If both can be billed, does CPT code 17110 get modifier 59?
A: Both codes can be billed. No modifier is needed. The code with the lower RVUs will be reduced by 50% (just in case you wanted to know about the reimbursement). Also, remember that neither of these codes is billed in units. You bill one unit no matter how many lesions are treated.
Q: If I pare some warts on the foot and then treat the warts by destruction, can I bill both CPT codes 11055 and 17110? Do I need a modifier?
A: You cannot bill 11055, 11056, or 11057 for warts. These codes are only to be used for the paring of corns and calluses. There is no way to bill for paring of warts. Therefore, you can only bill using CPT code 17110.
Q: I ordered my 2007 CPT book from the Ingenix. I have read your information indicating that we can no longer use CPT codes 17000, 17003, and 17004 for warts, only actinic keratoses. You must have received some incorrect information, or perhaps these changes only apply to Medicare and not to all commercial carriers.
On the page where it describes Destruction of Benign or Premalignant Lesion, right after CPT code 17111 it states, “To report the destruction of common or plantar warts, consult CPT codes 17000, 17003 and 17004.” You probably need to get your information straight.
A: Thanks for the input, but you are incorrect — and so is Ingenix. The company made some huge typos when they designed the book — and that is certainly their biggest one.
You need to read the entire section, starting with the description of 17000 and 17000. Right underneath the end of the descriptor for CPT code 17003 it states, “See 17110, 17111 for destruction of common or plantar warts.” Plus the definition changes for CPT codes 17000 to 17004 states, “Destruction of premalignant lesions.” It does not include non-premalignant or benign lesions.
Obviously, the information listed at the end of CPT code 17111 is a huge error and certainly contradicts what the instructions stated on the other codes.
Since CPT 2007 changed the definitions of 17000, 17003, 17004, 17110 and 17111, the changes apply to all insurance carriers, not just Medicare.
I try to keep up with everything and verify my sources.
I certainly have made my share of mistakes over the past 35 years, but I am very careful when I relate major changes such as these. I check all my insider resources, I check the Federal Register, follow the AAD’s memos, and read the entire CPT book, page by page, index by index. The reason I have become a reliable resource for dermatologists over the years is because they can depend on my information. I work hard to maintain your confidence, but I do appreciate your comments.
By the way, I would call Ingenix and ask for a refund. The next time, order your CPT book directly from the AMA; that’s what I do.
I operate a national coding question fax hotline service that is in place for my subscribers to contact me all through the term of their subscription and ask me any coding questions or questions related to billing. I have been doing this for about 15 years now.
Yet, during all of this time, I have never received more faxes in the beginning of the year than I have the first 2 weeks of 2007. I’ve received more during this time than I usually get in 2 months!
I have virtually been spending 2 to 4 hours of each working day answering these faxes. (Believe me, this is not a solicitation for more business. I am trying to cut back on my workload — not trying to generate more activity!)
My point is that the year 2007 is an unprecedented year with respect to the changes that will affect dermatologists. For example, the following changes have occurred:
• There are five new CPT codes for Mohs.
• The multiple surgery reduction rule now applies to the Mohs codes.
• New descriptors for CPT codes 17000, 17003, 17004, 17110, and 17111 were introduced.
• The destruction codes for benign and premalignant lesions seem to be confusing everyone. Most confusing is trying to figure out which codes are bundled and which are not and, if they are bundled, which code gets modifier 59.
It gets even worse. This change alone has generated a slew of questions, such as the following:
• What if the dermatologist does a destruction of a malignant lesion on the same date of service that a wart and some actinic keratoses are destroyed?
• Is modifier 59 required? If so, where?
• Will the services be subject to the multiple surgery reduction rule and, if so, which services will be reduced?
• What will happen if you use modifier 59 when it is not needed?
The questions are endless. No matter how often I explain the changes, whether in my newsletters, in faxes, or in journal articles, the questions keep pouring in and more confusion ensues.
That leads me to this month’s column. Here, I’ll try to answer some of the more interesting questions I have received as well as the ones that seem to plague everyone. Here it goes! I hope this helps.
Q: My patient was in a postoperative period (let’s say a 90-day global). The patient returned after 2 months, at which time I treated the following lesions (all by destruction): two actinic keratoses, 15 warts, and one malignant lesion. I billed the following CPT codes with the following modifiers:
17000 -79
17003 -79
17111 -79
17263-59 -79.
Did I use modifier 59 correctly? Which services will be reduced by the insurance carrier?
A: First, the fact that you asked me if you used the modifier 59 correctly lets me know that you do not have the current version of Medicare’s Correct Coding Initiative (CCI) at your fingertips. This is an absolute must. There is no way you can guess the combinations in Version 13.0 (which became effective Jan. 1, 2007). The bundles are so crazy and make no sense whatsoever.
Guessing will only result in your office’s receiving excessive denials. Appeals will be difficult to reverse.
Based on the new updates in the Medicare CCI edits, if you append modifier 59 to a CPT code where it is not needed, you will get a denial because the computer will be looking for the other code that you are trying to unbundle it with (e.g., the other part of the pair). For example, if you bill CPT codes 11642 and 13132 and put modifier 59 on either of the two codes (none are needed, by the way), the code with modifier 59 will be denied because it doesn’t match up to any of the pair combinations in the CCI.
Look up all of the codes you are billing because they come up in pairs. Always look up all combinations to see if any of the two or more surgical services you plan to bill are bundled.
With respect to your question, you made several mistakes. First, the postoperative modifier should always appear first, if more than one modifier is required on the claim. The modifier sequence should be -79 -59, not -59 -79. Secondly, modifier 59 should be appended to CPT code 17111, not 17263. For example:
• 17000 -79
• 17003 -79
• 17111 -79 -59
• 17263 -79.
If you look up CPT code 17110 in the CCI, it is not bundled with CPT code 17263. But if you look up CPT code 17000, it is bundled with CPT code 17111; hence the modifier goes on code 17111.
To show you how absolutely nonsensical the combinations are in Version 13.0 of the CCI, here are a few more examples. See if you can guess where modifier 59 should go. Don’t look at the answers below until you have put modifier 59 on the following eight sets of CPT codes.
I wouldn’t guess because there is no rhyme or reason for the combinations. It is really difficult.
a.17000, 17003, 17262
b.17000, 17110
c. 17000, 17111
d. 17004, 17111
e. 17000, 17262, 17111
f. 17000, 17110, 17264
g. 17004,17262, 17110
h. 17004, 17282
The answers are as follows: (a) none needed; (b) none needed; (c) 17111 -59; (d) 17004 -59; (e) 17262 -59; (f) none needed; (g) 17262 -59 and (h) 17004 -59.
So how did you do? I bet most of you got at least half or more incorrect (unless you used the most recent version of the CCI).
Keep in mind that every time you put the modifier where it was not needed that CPT code will be denied. In addition, the CPT code that did not get modifier 59 when it was needed will also be denied.
The only solution is getting a subscription to the CCI. It is published and updated quarterly by the National Technical Information Services (NTIS). Inga Ellzey Practice Group has several products that make it easy to check your bundling tables in the CCI, or you can obtain the list directly from CMS (although the files are not organized or easy to decipher). You will just receive the raw data files.
No matter where you purchase the CCI, you have to get a yearly subscription so you can always have the most current version at your finger tips.
Now with respect to the multiple surgery reductions, in your example and mine, all the codes are subject to reduction rules except CPT code 17003. For Medicare claims, CPT code 17004 is also exempt from reductions. I’ll show you at what rate the above examples would be paid based on 2007 RVUs.
• 17000 — 50%
• 17003 — 100%
• 17111 — 50%
• 17263 — 100%
Non-Medicare
a. 17000 — 50%, 17003 — 100%
17262 — 100%
b. 17000 — 50%, 17110 — 100%
c. 17000 — 50%, 17111 — 100%
d. 17004 — 100%, 17111 — 50%
e. 17000 — 50%, 17262 — 100%
17111 — 50%
f. 17000 — 50%, 17110 — 50%,
17264 — 100%
g. 17004 — 100%, 17262 — 50%,
17110 —50%
h. 17004 — 50%, 17282 — 100%.
Medicare
All reductions are the same, except the following:
d. 17004 — 100%, 17111 — 100%
g. 17004 — 100%, 17262 — 100%, 17110 — 50%
h. 17004 — 100%, 17282 — 100%.
Q: I billed CPT codes 11100 and 67810 to Medicare. I put modifier 59 on CPT code 11100, and it was denied. Although I appealed the claim with notes, the insurer still upheld its original denial. Why was this not correctly paid?
A: This is another example of where you put modifier 59 when none was needed. The denial was caused by improper use of modifier 59. You won’t get the claim denial reversed with just notes. You’ll have to convince the carrier (good luck) to remove the modifier from the claim.
Q: If a patient comes into the office and has condyloma cryosurgically destroyed in the groin area as well as on the penis, can we charge using CPT codes 17110 and 54056 since they are from different anatomic sites? If both can be billed, does CPT code 17110 get modifier 59?
A: Both codes can be billed. No modifier is needed. The code with the lower RVUs will be reduced by 50% (just in case you wanted to know about the reimbursement). Also, remember that neither of these codes is billed in units. You bill one unit no matter how many lesions are treated.
Q: If I pare some warts on the foot and then treat the warts by destruction, can I bill both CPT codes 11055 and 17110? Do I need a modifier?
A: You cannot bill 11055, 11056, or 11057 for warts. These codes are only to be used for the paring of corns and calluses. There is no way to bill for paring of warts. Therefore, you can only bill using CPT code 17110.
Q: I ordered my 2007 CPT book from the Ingenix. I have read your information indicating that we can no longer use CPT codes 17000, 17003, and 17004 for warts, only actinic keratoses. You must have received some incorrect information, or perhaps these changes only apply to Medicare and not to all commercial carriers.
On the page where it describes Destruction of Benign or Premalignant Lesion, right after CPT code 17111 it states, “To report the destruction of common or plantar warts, consult CPT codes 17000, 17003 and 17004.” You probably need to get your information straight.
A: Thanks for the input, but you are incorrect — and so is Ingenix. The company made some huge typos when they designed the book — and that is certainly their biggest one.
You need to read the entire section, starting with the description of 17000 and 17000. Right underneath the end of the descriptor for CPT code 17003 it states, “See 17110, 17111 for destruction of common or plantar warts.” Plus the definition changes for CPT codes 17000 to 17004 states, “Destruction of premalignant lesions.” It does not include non-premalignant or benign lesions.
Obviously, the information listed at the end of CPT code 17111 is a huge error and certainly contradicts what the instructions stated on the other codes.
Since CPT 2007 changed the definitions of 17000, 17003, 17004, 17110 and 17111, the changes apply to all insurance carriers, not just Medicare.
I try to keep up with everything and verify my sources.
I certainly have made my share of mistakes over the past 35 years, but I am very careful when I relate major changes such as these. I check all my insider resources, I check the Federal Register, follow the AAD’s memos, and read the entire CPT book, page by page, index by index. The reason I have become a reliable resource for dermatologists over the years is because they can depend on my information. I work hard to maintain your confidence, but I do appreciate your comments.
By the way, I would call Ingenix and ask for a refund. The next time, order your CPT book directly from the AMA; that’s what I do.
I operate a national coding question fax hotline service that is in place for my subscribers to contact me all through the term of their subscription and ask me any coding questions or questions related to billing. I have been doing this for about 15 years now.
Yet, during all of this time, I have never received more faxes in the beginning of the year than I have the first 2 weeks of 2007. I’ve received more during this time than I usually get in 2 months!
I have virtually been spending 2 to 4 hours of each working day answering these faxes. (Believe me, this is not a solicitation for more business. I am trying to cut back on my workload — not trying to generate more activity!)
My point is that the year 2007 is an unprecedented year with respect to the changes that will affect dermatologists. For example, the following changes have occurred:
• There are five new CPT codes for Mohs.
• The multiple surgery reduction rule now applies to the Mohs codes.
• New descriptors for CPT codes 17000, 17003, 17004, 17110, and 17111 were introduced.
• The destruction codes for benign and premalignant lesions seem to be confusing everyone. Most confusing is trying to figure out which codes are bundled and which are not and, if they are bundled, which code gets modifier 59.
It gets even worse. This change alone has generated a slew of questions, such as the following:
• What if the dermatologist does a destruction of a malignant lesion on the same date of service that a wart and some actinic keratoses are destroyed?
• Is modifier 59 required? If so, where?
• Will the services be subject to the multiple surgery reduction rule and, if so, which services will be reduced?
• What will happen if you use modifier 59 when it is not needed?
The questions are endless. No matter how often I explain the changes, whether in my newsletters, in faxes, or in journal articles, the questions keep pouring in and more confusion ensues.
That leads me to this month’s column. Here, I’ll try to answer some of the more interesting questions I have received as well as the ones that seem to plague everyone. Here it goes! I hope this helps.
Q: My patient was in a postoperative period (let’s say a 90-day global). The patient returned after 2 months, at which time I treated the following lesions (all by destruction): two actinic keratoses, 15 warts, and one malignant lesion. I billed the following CPT codes with the following modifiers:
17000 -79
17003 -79
17111 -79
17263-59 -79.
Did I use modifier 59 correctly? Which services will be reduced by the insurance carrier?
A: First, the fact that you asked me if you used the modifier 59 correctly lets me know that you do not have the current version of Medicare’s Correct Coding Initiative (CCI) at your fingertips. This is an absolute must. There is no way you can guess the combinations in Version 13.0 (which became effective Jan. 1, 2007). The bundles are so crazy and make no sense whatsoever.
Guessing will only result in your office’s receiving excessive denials. Appeals will be difficult to reverse.
Based on the new updates in the Medicare CCI edits, if you append modifier 59 to a CPT code where it is not needed, you will get a denial because the computer will be looking for the other code that you are trying to unbundle it with (e.g., the other part of the pair). For example, if you bill CPT codes 11642 and 13132 and put modifier 59 on either of the two codes (none are needed, by the way), the code with modifier 59 will be denied because it doesn’t match up to any of the pair combinations in the CCI.
Look up all of the codes you are billing because they come up in pairs. Always look up all combinations to see if any of the two or more surgical services you plan to bill are bundled.
With respect to your question, you made several mistakes. First, the postoperative modifier should always appear first, if more than one modifier is required on the claim. The modifier sequence should be -79 -59, not -59 -79. Secondly, modifier 59 should be appended to CPT code 17111, not 17263. For example:
• 17000 -79
• 17003 -79
• 17111 -79 -59
• 17263 -79.
If you look up CPT code 17110 in the CCI, it is not bundled with CPT code 17263. But if you look up CPT code 17000, it is bundled with CPT code 17111; hence the modifier goes on code 17111.
To show you how absolutely nonsensical the combinations are in Version 13.0 of the CCI, here are a few more examples. See if you can guess where modifier 59 should go. Don’t look at the answers below until you have put modifier 59 on the following eight sets of CPT codes.
I wouldn’t guess because there is no rhyme or reason for the combinations. It is really difficult.
a.17000, 17003, 17262
b.17000, 17110
c. 17000, 17111
d. 17004, 17111
e. 17000, 17262, 17111
f. 17000, 17110, 17264
g. 17004,17262, 17110
h. 17004, 17282
The answers are as follows: (a) none needed; (b) none needed; (c) 17111 -59; (d) 17004 -59; (e) 17262 -59; (f) none needed; (g) 17262 -59 and (h) 17004 -59.
So how did you do? I bet most of you got at least half or more incorrect (unless you used the most recent version of the CCI).
Keep in mind that every time you put the modifier where it was not needed that CPT code will be denied. In addition, the CPT code that did not get modifier 59 when it was needed will also be denied.
The only solution is getting a subscription to the CCI. It is published and updated quarterly by the National Technical Information Services (NTIS). Inga Ellzey Practice Group has several products that make it easy to check your bundling tables in the CCI, or you can obtain the list directly from CMS (although the files are not organized or easy to decipher). You will just receive the raw data files.
No matter where you purchase the CCI, you have to get a yearly subscription so you can always have the most current version at your finger tips.
Now with respect to the multiple surgery reductions, in your example and mine, all the codes are subject to reduction rules except CPT code 17003. For Medicare claims, CPT code 17004 is also exempt from reductions. I’ll show you at what rate the above examples would be paid based on 2007 RVUs.
• 17000 — 50%
• 17003 — 100%
• 17111 — 50%
• 17263 — 100%
Non-Medicare
a. 17000 — 50%, 17003 — 100%
17262 — 100%
b. 17000 — 50%, 17110 — 100%
c. 17000 — 50%, 17111 — 100%
d. 17004 — 100%, 17111 — 50%
e. 17000 — 50%, 17262 — 100%
17111 — 50%
f. 17000 — 50%, 17110 — 50%,
17264 — 100%
g. 17004 — 100%, 17262 — 50%,
17110 —50%
h. 17004 — 50%, 17282 — 100%.
Medicare
All reductions are the same, except the following:
d. 17004 — 100%, 17111 — 100%
g. 17004 — 100%, 17262 — 100%, 17110 — 50%
h. 17004 — 100%, 17282 — 100%.
Q: I billed CPT codes 11100 and 67810 to Medicare. I put modifier 59 on CPT code 11100, and it was denied. Although I appealed the claim with notes, the insurer still upheld its original denial. Why was this not correctly paid?
A: This is another example of where you put modifier 59 when none was needed. The denial was caused by improper use of modifier 59. You won’t get the claim denial reversed with just notes. You’ll have to convince the carrier (good luck) to remove the modifier from the claim.
Q: If a patient comes into the office and has condyloma cryosurgically destroyed in the groin area as well as on the penis, can we charge using CPT codes 17110 and 54056 since they are from different anatomic sites? If both can be billed, does CPT code 17110 get modifier 59?
A: Both codes can be billed. No modifier is needed. The code with the lower RVUs will be reduced by 50% (just in case you wanted to know about the reimbursement). Also, remember that neither of these codes is billed in units. You bill one unit no matter how many lesions are treated.
Q: If I pare some warts on the foot and then treat the warts by destruction, can I bill both CPT codes 11055 and 17110? Do I need a modifier?
A: You cannot bill 11055, 11056, or 11057 for warts. These codes are only to be used for the paring of corns and calluses. There is no way to bill for paring of warts. Therefore, you can only bill using CPT code 17110.
Q: I ordered my 2007 CPT book from the Ingenix. I have read your information indicating that we can no longer use CPT codes 17000, 17003, and 17004 for warts, only actinic keratoses. You must have received some incorrect information, or perhaps these changes only apply to Medicare and not to all commercial carriers.
On the page where it describes Destruction of Benign or Premalignant Lesion, right after CPT code 17111 it states, “To report the destruction of common or plantar warts, consult CPT codes 17000, 17003 and 17004.” You probably need to get your information straight.
A: Thanks for the input, but you are incorrect — and so is Ingenix. The company made some huge typos when they designed the book — and that is certainly their biggest one.
You need to read the entire section, starting with the description of 17000 and 17000. Right underneath the end of the descriptor for CPT code 17003 it states, “See 17110, 17111 for destruction of common or plantar warts.” Plus the definition changes for CPT codes 17000 to 17004 states, “Destruction of premalignant lesions.” It does not include non-premalignant or benign lesions.
Obviously, the information listed at the end of CPT code 17111 is a huge error and certainly contradicts what the instructions stated on the other codes.
Since CPT 2007 changed the definitions of 17000, 17003, 17004, 17110 and 17111, the changes apply to all insurance carriers, not just Medicare.
I try to keep up with everything and verify my sources.
I certainly have made my share of mistakes over the past 35 years, but I am very careful when I relate major changes such as these. I check all my insider resources, I check the Federal Register, follow the AAD’s memos, and read the entire CPT book, page by page, index by index. The reason I have become a reliable resource for dermatologists over the years is because they can depend on my information. I work hard to maintain your confidence, but I do appreciate your comments.
By the way, I would call Ingenix and ask for a refund. The next time, order your CPT book directly from the AMA; that’s what I do.
