Friday, April 20, 2012

CO2 Dermabrasion and Multiple Allergens

ICD9 Codes

Question: How would you code for CO2 laser dermabrasion for treating a basal cell carcinoma?

Answer: You should report 15780 (Dermabrasion; total face [e.g., for acne scarring, fine wrinkling, rhytids, general keratosis]), 15781 (... segmental, face), 15782 (... regional, other than face), or 15783 (... superficial, any site [e.g., tattoo removal]) for a dermabrasion procedure.

For showing that the procedure is medically necessary, you must link the CPT code to an ICD-9 codes from the 173.0-173.9 (Other malignant neoplasm of skin) series. You should select the code from that series that signifies the site of the carcinoma.

Warning: Most carriers think of dermabrasion procedures to be cosmetic and will reimburse you for them simply under definite medical circumstances. For instance, Aetna considers dermabrasion -- whether by dermaplaning or CO2 laser -- medically essential for elimination of superficial basal cell carcinomas as well as pre-cancerous actinic keratosis only when you meet two criteria:

  • conventional ways of removal for instance cryotherapy, curettage, and excision are impractical owing to the number and distribution of the lesions, and
  • the member has failed a trial of 5-fluorouracil (5-FU) (Efudex), lest contraindicated.

Testing Multiple Allergens
Question: Your dermatologist scratch- tested a patient, who has problems of skin rashes, for reactions to dogs, cats, ragweed, oak, maple, penicillin, dust mites, as well as bees. What codes must you report?

Answer: You must report 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction…) x 4 units for the ragweed, oak, maple, as well as dust mites, and CPT code 95010 (Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests) x 4 units for the dog, cat, penicillin, and bee stings.

A dermatologist has numerous ways of determining the source of a patient's skin rashes. Furthermore, they generally want to test several substances all at once. Keep in mind that every substance counts as a distinct test. Make certain to code for every single allergen administered by putting the number in the "units" field of your claim form.

Quick fact: The percutaneous test is also termed as scratch test, prick test or puncture test. Here, the dermatologist applies test solutions of probable allergens to scratches or shallow punctures on a patient's skin.

The kind of solutions your dermatologist applies will decide the code you report: CPT code 95004 for allergenic extracts and CPT codes 95010 for antibiotics, biologicals, stinging insects, and local anesthetic agents.