As dermatologists we used to be quite lucky to have several “multiple surgery reduction exempt” codes for many years. Unfortunately, they all have disappeared one by one.
The most recent insult with the greatest economic impact was the elimination of Mohs codes from “multiple surgery reduction exempt” codes. These CPT codes are also known as modifier 51 exempt codes because modifier 51 indicates that you will get reimbursed at 50% of the allowable amount for that CPT code.
Sometimes, the modifier 51 exempt codes are confused with the add-on codes. However, the add-on codes are distinct in that they are:
• inherently reduced 50% anyway,
• don’t require modifier 51,
• and are not subject to multiple surgery reduction codes.
In this column, I’ll review appropriate use of the add-on codes
The Add-On Codes at a Glance
The add-on codes include the following:
11100 Skin biopsy, first one
Add on
11101 Skin biopsy, each additional lesion 11200 Removal of skin tags, up to and including 15 lesions
Add on
11201 Each additional 10 lesions 11000 Debridement of eczematous or infected skin, up to 10% body surface area
Add on
11001 Each additional 10% of the body surface area
11730 Avulsion of nail plate, single
Add on
11732 Each additional nail plate 13101 Repair, complex trunk 2.6 cm to 7.5 cm
Add on
13102 Each additional 5 cm or less (This will repeat in each complex repair group according to the anatomical location)
15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 cm2 or 1% of body surface area of infants and children
Add on
15003 Each additional 100 cm2 or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure)
15100 Split-thickness autograft, trunk, arms, legs; first 100 cm2 or less, or 1% of body area in infants and children (except 15050)
Add on
15101 Each additional 100 cm2, or each additional 1% of body area of infants or children, or part thereof (list separately in addition to code for primary procedure)
17000 Destruction of pre-malignant lesion, first lesion
Add on
17003 Second through 14th lesion, each
17311 Mohs micrographic surgery, first stage (head, neck, hands, feet, genitalia)
Add on
17312 Each additional stage (head, neck, hands, feet, genitalia)
17313 Mohs micrographic surgery, first stage (trunk, arms, legs)
Add on
17314 Mohs micrographic surgery Each additional stage (trunk, arms, legs)
One Question Remains
So, the billing question of the month is:
“Which is the still remaining modifier 51 exempt code commonly used in dermatology?”
Answer: 17004 — Destruction of pre-malignant lesions, 15 or more. You can still use this code with any other surgical procedure code, and both of these codes will be reimbursed at 100%.
Dr. Kircik is an Associate Clinical Professor of Dermatology at Indiana University Medical Center. He is also the Medical Director of Derm Research, PLLC, and Physicians Skin Care, PLLC, in Louisville, KY.
As dermatologists we used to be quite lucky to have several “multiple surgery reduction exempt” codes for many years. Unfortunately, they all have disappeared one by one.
The most recent insult with the greatest economic impact was the elimination of Mohs codes from “multiple surgery reduction exempt” codes. These CPT codes are also known as modifier 51 exempt codes because modifier 51 indicates that you will get reimbursed at 50% of the allowable amount for that CPT code.
Sometimes, the modifier 51 exempt codes are confused with the add-on codes. However, the add-on codes are distinct in that they are:
• inherently reduced 50% anyway,
• don’t require modifier 51,
• and are not subject to multiple surgery reduction codes.
In this column, I’ll review appropriate use of the add-on codes
The Add-On Codes at a Glance
The add-on codes include the following:
11100 Skin biopsy, first one
Add on
11101 Skin biopsy, each additional lesion 11200 Removal of skin tags, up to and including 15 lesions
Add on
11201 Each additional 10 lesions 11000 Debridement of eczematous or infected skin, up to 10% body surface area
Add on
11001 Each additional 10% of the body surface area
11730 Avulsion of nail plate, single
Add on
11732 Each additional nail plate 13101 Repair, complex trunk 2.6 cm to 7.5 cm
Add on
13102 Each additional 5 cm or less (This will repeat in each complex repair group according to the anatomical location)
15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 cm2 or 1% of body surface area of infants and children
Add on
15003 Each additional 100 cm2 or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure)
15100 Split-thickness autograft, trunk, arms, legs; first 100 cm2 or less, or 1% of body area in infants and children (except 15050)
Add on
15101 Each additional 100 cm2, or each additional 1% of body area of infants or children, or part thereof (list separately in addition to code for primary procedure)
17000 Destruction of pre-malignant lesion, first lesion
Add on
17003 Second through 14th lesion, each
17311 Mohs micrographic surgery, first stage (head, neck, hands, feet, genitalia)
Add on
17312 Each additional stage (head, neck, hands, feet, genitalia)
17313 Mohs micrographic surgery, first stage (trunk, arms, legs)
Add on
17314 Mohs micrographic surgery Each additional stage (trunk, arms, legs)
One Question Remains
So, the billing question of the month is:
“Which is the still remaining modifier 51 exempt code commonly used in dermatology?”
Answer: 17004 — Destruction of pre-malignant lesions, 15 or more. You can still use this code with any other surgical procedure code, and both of these codes will be reimbursed at 100%.
Dr. Kircik is an Associate Clinical Professor of Dermatology at Indiana University Medical Center. He is also the Medical Director of Derm Research, PLLC, and Physicians Skin Care, PLLC, in Louisville, KY.
As dermatologists we used to be quite lucky to have several “multiple surgery reduction exempt” codes for many years. Unfortunately, they all have disappeared one by one.
The most recent insult with the greatest economic impact was the elimination of Mohs codes from “multiple surgery reduction exempt” codes. These CPT codes are also known as modifier 51 exempt codes because modifier 51 indicates that you will get reimbursed at 50% of the allowable amount for that CPT code.
Sometimes, the modifier 51 exempt codes are confused with the add-on codes. However, the add-on codes are distinct in that they are:
• inherently reduced 50% anyway,
• don’t require modifier 51,
• and are not subject to multiple surgery reduction codes.
In this column, I’ll review appropriate use of the add-on codes
The Add-On Codes at a Glance
The add-on codes include the following:
11100 Skin biopsy, first one
Add on
11101 Skin biopsy, each additional lesion 11200 Removal of skin tags, up to and including 15 lesions
Add on
11201 Each additional 10 lesions 11000 Debridement of eczematous or infected skin, up to 10% body surface area
Add on
11001 Each additional 10% of the body surface area
11730 Avulsion of nail plate, single
Add on
11732 Each additional nail plate 13101 Repair, complex trunk 2.6 cm to 7.5 cm
Add on
13102 Each additional 5 cm or less (This will repeat in each complex repair group according to the anatomical location)
15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 cm2 or 1% of body surface area of infants and children
Add on
15003 Each additional 100 cm2 or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure)
15100 Split-thickness autograft, trunk, arms, legs; first 100 cm2 or less, or 1% of body area in infants and children (except 15050)
Add on
15101 Each additional 100 cm2, or each additional 1% of body area of infants or children, or part thereof (list separately in addition to code for primary procedure)
17000 Destruction of pre-malignant lesion, first lesion
Add on
17003 Second through 14th lesion, each
17311 Mohs micrographic surgery, first stage (head, neck, hands, feet, genitalia)
Add on
17312 Each additional stage (head, neck, hands, feet, genitalia)
17313 Mohs micrographic surgery, first stage (trunk, arms, legs)
Add on
17314 Mohs micrographic surgery Each additional stage (trunk, arms, legs)
One Question Remains
So, the billing question of the month is:
“Which is the still remaining modifier 51 exempt code commonly used in dermatology?”
Answer: 17004 — Destruction of pre-malignant lesions, 15 or more. You can still use this code with any other surgical procedure code, and both of these codes will be reimbursed at 100%.
Dr. Kircik is an Associate Clinical Professor of Dermatology at Indiana University Medical Center. He is also the Medical Director of Derm Research, PLLC, and Physicians Skin Care, PLLC, in Louisville, KY.
