Having a tough time reporting milia treatments? Part of the challenge is discriminating between acne surgery codes and destruction codes. These four medical billing and coding clues help you evade big headaches on possible denials.
Clue 1: Explore Destruction vs. Removal
The major difference between 10040 (Acne surgery -- e.g., marsupialization, opening or removal of multiple milia, comedones, cysts and pustules) and 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) is that the CPT code 17110 is a destruction code while the 10040 code is a removal code.
"Code choices must be fairly simple by definition alone. The code 10040 signifies that an incision is made into the cyst or milia for removal and code 17110 is for destruction.
Hint: In CPT, any code with a prefix of "17" is a destruction code. As mentioned in 17110's description, the most common forms of destruction include the application of liquid nitrogen or other chemical agent (a.k.a. cryosurgery), curettage, electrodessication, or the use of a laser.
Keep in mind that your dermatologist generally removes a milia by using a comedone extractor, which is a tool of the size of tweezers.
Clue 2: Choose Destruction Series Based on Diagnosis
The CPT code series 17110-17111 states the destruction of benign lesions that is medically necessary. In case you'd use a destruction code for reporting milia treatment, you must keep in mind that 17110 is for up to 14 lesions while 17111 (…15 or more lesions) is for 15 or more lesions treated at one time. Therefore, you will never code CPT codes 17110 and 17111 together on any patient or at any given time.
Red flag: While assigning codes for benign or premalignant lesions, the number of lesions definitely matters. Moreover, a proper ICD-9 code must come with reporting 17110-17111. Some of the most common include ICD- 9 code 702.11 (Inflamed seborrheic keratosis) 078.10 (Viral warts, unspecified), 706.2 (Sebaceous cyst), and 078.19 (Other specified viral warts [e.g., common wart, flat wart, verruca plantaris]), to which group milia belongs.
Clue 3: Understand I&D of Foreign Body
I&D means "incision and drainage" and frequently applies to to the removal of a foreign body in the skin as well as subcutaneous tissue (including nails). It is actually a common treatment for an abscess in which a scalpel or needle is inserted into the skin covering the pus and the pus is drained. While treating milia this way, 10040 is applicable. Whereas most insurance carriers may deny a claim for 10040, submitted with a diagnosis of simple acne, they will generally pay for a diagnosis of symptomatic milia for removal (706.2, Sebaceous cyst). The reason is that they consider ICD-9 code 706.2 as medically necessary. A decent example of symptomatic milia would be aninflamed milia on the nasal bridge irritated by eyeglasses.
Clue 4: See Symptomatic in the Big Picture
Milias are actually tiny white bumps of keratin in the glands of the skin. They are very common in newborns' faces -- commonly on the tip of the nose or chin -- however are also found in adults. Medicare and maximum carriers have a benign lesion destruction/removal policy that you should meet in order to bill milia treatment. Look out for the appropriate symptoms that must be indicated in your dermatologist's pathology report, for example:
- clinical suspicion for malignancy
- irritation (various carriers differ on policies for this symptom).