The Current Procedural Terminology (CPT) codes form a standardized language used by healthcare providers for billing and reporting purposes. CPT Code 17000 is a procedural code used primarily in dermatology to report the destruction of superficial skin growths. It serves as the foundation for billing the service of removing the first or only lesion treated during a single patient encounter.
What CPT Code 17000 Covers
CPT Code 17000 is defined for the destruction of a premalignant skin lesion, meaning a growth that has the potential to become cancerous. The most common example is actinic keratosis (AK), which appears as rough, scaly patches typically found on sun-exposed areas. Actinic keratoses are considered precancerous, and their destruction is a medically necessary procedure to prevent progression to squamous cell carcinoma.
The code applies only to the destruction of the initial lesion treated during a visit. While some destruction codes cover both benign and premalignant lesions, 17000 is specifically designated for the premalignant category, such as AKs. If a patient has a single actinic keratosis treated with cryosurgery, CPT 17000 is the code reported for that service.
Understanding the Lesion Count Limit
CPT 17000 is strictly reserved for the first premalignant lesion destroyed in a session and must only be reported once. When a patient has multiple lesions removed, providers must use specific add-on codes to account for the subsequent treatments.
For the second through the fourteenth lesions destroyed, the add-on code CPT 17003 is utilized. This code is billed per lesion. If a provider destroys five actinic keratoses, they report CPT 17000 once for the first lesion and CPT 17003 four times for the remaining four.
If a provider destroys fifteen or more lesions, a different coding rule applies. The provider reports CPT 17004 just once, and this single code covers the destruction of all fifteen or more lesions. CPT 17004 is a standalone code and must not be used in conjunction with CPT 17000 or CPT 17003 for the same date of service. Using the codes incorrectly is a common error that leads to claim denials.
The Procedures Used for Destruction
The “destruction” referred to in CPT 17000 covers several common clinical techniques used to eliminate the skin lesion. The code itself covers the method of destruction rather than the specific diagnosis. One of the most frequently used methods is cryosurgery, which involves the controlled application of extreme cold, typically liquid nitrogen, to freeze and destroy the targeted cells.
Electrosurgery is another technique, where an electrical current is used to generate heat within the tissue, effectively burning away the lesion. Chemical destruction, often called chemosurgery or chemical cautery, involves applying a caustic chemical agent directly to the growth. Curettage, or scraping, may be used in conjunction with these methods to ensure complete removal of the abnormal tissue.
Essential Documentation Requirements
Accurate and detailed medical documentation is necessary for a provider to receive reimbursement for services billed under CPT 17000. The medical record must clearly support the medical necessity of the procedure, which generally means confirming the lesion is premalignant, such as actinic keratosis. Providers must include the specific diagnosis code (ICD-10 code) that corresponds to the condition being treated.
For auditing and payment purposes, the documentation must explicitly state the exact number of lesions destroyed during the visit. Furthermore, the specific anatomical location of each treated lesion needs to be recorded, such as “three lesions on the right forearm”. Without this clear documentation, especially regarding the count and location, claims that use CPT 17000 and the add-on code CPT 17003 will likely face denial from insurance payers.