Two Removals are Similar and Different

To avoid raised rejection of your medical billing claims for similar procedures that will be coded due to different removals or different parts of the body affected, you need to make sure you have iron-clad documentation.

In some cases, you will come across two removals that are very similar, but different. For example, if a pediatrician removes an extra digit from a newborn’s hand, and also removes a skin tag from the newborn, the removal of an extra digit and the removal of a skin tag fall under the same CPT code but fall into different ICD-9 codes.

For these two procedures, you should report 11200 (11200 is the removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions). This code identifies “the use of scissors or any sharp methods, ligature strangulation, electrosurgical destruction, or any combination of the treatment methods including electrosurgical techniques or the use of chemicals” according to the notes on skin tag removal from the CPT.

It is important to remember that, although the pediatrician has performed two removals on the newborn patient, you should only bill code 11200 one time. This is because the code 11200 is removal of up to and including fifteen lesions from any area. Two ICD-9 codes should be used, from the 740-759 section, which is Congenital anomalies.

In cases such as this, you should report 755.01 (which is Polydactyly of fingers) for the extra digit or accessory finger. The skin tag diagnosis should be listed as 757.39, which is ‘Other specified anomalies of skin; other’ which includes as an example, “accessory skin tags, congenital.”

This should provide you with a simple solution to a seemingly difficult medical billing problem.

View all Articles by: Kathryn Etienne, CCS-P