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Internal Medicine Coding Alert

Reader Question:

Single Lesion Removal Using Different Techniques

Question: Our internal medicine physician recently performed removal of a plantar wart approximately 5mm in diameter. He initially shaved the lesion and then cauterized it with silver nitrate. He finally injected it with .01 ml of Candida skin test antigen. What CPT® code(s) should I report for the procedure? I am thinking of reporting 11305, 11900 and 17110. Is this appropriate?

Michigan Subscriber

Answer: Even though your physician performed three different procedures, namely, shaving, cautery, and intralesional injection, you cannot report three CPT® codes for the removal of a single lesion. For this reason, you cannot report 11305 (Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less), 11900 (Injection, intralesional; up to and including 7 lesions) and 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) together for this procedure.

Also, Correct Coding Initiative (CCI) edits bundle the CPT® codes 11305 and 11900 into 17110. Even though the modifier indicator is ‘1,’ you should not unbundle these codes using a modifier, because your physician is removing a single lesion using three different methods and not three different lesions by these separate techniques.

So, in your case, you will only report 17110 as this represents the most extensive service and accurately describes the service; it forms the column 1 code in the edits, and the other two codes get bundled into 17110.