Terry Posted Tue 21st of August, 2012 22:40:44 PM
My provider recently went to an Inga Ellzey seminar at the American Academy of Dermatology conference. Inga told my doctor that the
measurement of the size for electrodessication and curettage should
take place after the third curettage, before the final
electrodessication. My doctor has previously been measuring after the first curettage. Do you have any documentation on the correct interpretation of this code? I cannot find anything that describes when the measurement should take place for correct code assignment. I have have read Inga's article on Size Matters published in 2009, however I am looking for documentation from CMS on the matter since they (and their affiliates) are the ones that would audit the record for correct coding.
SuperCoder Answered Fri 24th of August, 2012 20:53:30 PM
I am confused on the third electrodessication . It seems to me multiple repeated cuts are Mohs surgery not lesion destruction. Can you provide a link or email me Inga's article? You can email it to me directly at email@example.com or provide the email in your post.
I'll check on CMS documentation as well as my lesion removal experts.
Jen Godreau, CPC, CPMA, CPEDC
SuperCoder Answered Fri 24th of August, 2012 20:56:03 PM
Terry, Is this similar to what you read from http://www.aapc.com/memberarea/forums/showthread.php?t=52963:
So in auditing a file the clinician states, "size of lesion after curettment 0.9cm". I tell him that the measurement is the 'lesion diameter' but the guidelines do not indicate anything about 'after curettment'. He then shows me a manual published by a well know "Dermatology Coding Practice Management Group" that states, "In order to code for destruction of malignant lesions (CPT codes 17260 to 17286), the size of the lesion after curettage is measured. Do not use the resultant electrodessicated area as your measurement for code selection."
I can find no other source for this information. The Amercian Academy of Dermatology Coding Manual is silent on this topic, I have googled, I have sent queries to other Derm coders and can find no one else that knows anything about this.
How about this group? Any help on finding out where this information is coming from? I want to be fair but accurate when adressing the measurement of a destruction of a malignant lesion but I don't see anything published (aside from this one source) that talks about 'after curettment'. Thanks for your help. Judy:confused:
SuperCoder Answered Fri 24th of August, 2012 22:18:11 PM
Terry, I heard back from John Bishop and Pamela Biffle who are both national derm coding consultants. Neither have heard of Inga's guidance. They both teach the same guidelines that The Coding Institute teaches. I have included John's comment below. I will check with some CMS directors next week for their take. What is your jurisdiction?
I have always taught in my Skin,Wound Care and Derm seminars that these destruction codes are similar to excision of lesions or debridement codes.
Just like in excision coding, we measure the existing lesion's diameter and add any "extra margins" excised. So although the lesion is only 0.8 cm diameter, in fact the 0.3 margins now makes this lesion 1.4 cm excised.
Debridement coding is the same in CPT language. The ulcer was 1.2 x 2.3 cm. Then after sharp excisional debridement, the final size debrided was 2.4 x 3.8 cm = 9.12 cm sq.
Clinically, I can tell you that when I am excising or destroying some lesion, I don't even think of measuring until I'm sure I got everything, benign or malignant. When excising a malignant lesion, it "feels" very different on your scalpel blade. When that "weird" sensation stops, I tend to excise just a little more, then stop.
We even do the same in Breast masses. We excise until we think we have it all.
John F. Bishop, PA-C, CPC, CGSC, CPRC
AAPA National Chair Reimbursement Work Group
President John Bishop and Associates, LLC
Terry Posted Mon 27th of August, 2012 14:22:19 PM
Thanks for all of the feedback. I hope CMS can clarify this for us. Here is the link to the article by Inga.