Guidelines for Medical Coding and Billing for Skin Tags
Skin tags, also known as acrochordons, are benign, soft growths that often appear in areas where skin rubs against skin or clothing. While skin tags are typically harmless, they may cause cosmetic concerns or irritation, prompting patients to seek removal. For healthcare providers, accurate coding and billing for the treatment of skin tags are essential to ensure proper reimbursement and compliance with insurance requirements. In this blog, we will review the essential steps for coding and billing for skin tags, focusing on ICD-10, CPT, and HCPCS coding systems.
ICD-10 Coding for Skin Tags
The ICD-10 (International Classification of Diseases, 10th Edition) provides specific codes for skin tags that help categorize the condition. Skin tags are generally classified under L91 codes, which cover hypertrophic skin disorders. These codes should reflect the number and location of skin tags, and whether they are symptomatic or purely cosmetic.
Key ICD-10 Codes for Skin Tags:
- L91.0 – Hypertrophic skin, not elsewhere classified (used for skin tags in general)
- L91.8 – Other hypertrophic skin disorders (for other types of skin growths or conditions)
If the skin tag is related to a specific condition or disease, additional codes may be required. For instance, if the skin tag is part of a more complex dermatologic condition, such as a genetic disorder like neurofibromatosis, the coding may vary to reflect the underlying cause.
Example:
- L91.0: This code is most commonly used for a single skin tag or multiple skin tags, as it categorizes the benign condition without specifying a specific cause or location.
CPT Codes for Skin Tag Removal
When skin tags are removed for cosmetic or medical reasons, the procedure must be appropriately coded using CPT (Current Procedural Terminology) codes. The specific code will depend on the method of removal and the number of skin tags treated.
There are several common methods for removing skin tags, including cryotherapy (freezing), excision (cutting), and cauterization (burning). Each of these procedures is captured under different CPT codes.
Common CPT Codes for Skin Tag Removal:
- 11200 – Removal of skin tags (up to and including 15 lesions)
- 11201 – Removal of skin tags (each additional 10 lesions, or part thereof)
These codes are for the removal of skin tags via excision or other common methods. For instance, CPT 11200 is used when up to 15 skin tags are removed during the procedure. If more than 15 skin tags are removed, CPT 11201 is used for each additional group of 10 lesions.
Example:
- CPT 11200: Used for the removal of 10 skin tags.
- CPT 11201: Used if the provider removes 20 skin tags (since 10 would be included in the first code, and the second code is for the additional 10).
If the skin tag removal requires more complex procedures, such as the use of advanced techniques or anesthesia, additional codes may be needed.
Modifiers
Modifiers are often added to CPT codes to provide more detail about the service provided. When coding for skin tag removal, modifiers are used to clarify specific circumstances.
- Modifier 22: Increased procedural services. This modifier is used if the skin tag removal was more complicated than usual (e.g., if the procedure took longer due to the number or location of the tags).
- Modifier 25: Significant, separately identifiable evaluation and management (E/M) service. This modifier is used when the removal of skin tags is performed in conjunction with an office visit for a separate condition, making the visit and procedure separately identifiable.
CPT Modifiers https://codingclarified.com/cpt-medical-modifiers/
Example:
- CPT 11200-22: Used when the removal of skin tags is more complicated than usual.
- CPT 11200-25: Used when skin tag removal is performed during an office visit for another unrelated issue.
Billing Considerations for Skin Tag Removal
Proper billing for skin tag removal services requires careful documentation and coding. Several factors influence the billing process, such as whether the removal is considered cosmetic or medically necessary. Insurance companies may have different criteria for coverage based on the reason for removal, and the procedure may be covered under certain conditions.
1. Cosmetic vs. Medical Necessity:
Skin tag removal is often considered a cosmetic procedure, but it may be covered by insurance if the tags are causing pain, irritation, or other medical issues. If the procedure is deemed cosmetic, the patient may be responsible for out-of-pocket costs.
- Cosmetic Procedure: If the removal is solely for cosmetic purposes, it may not be covered by insurance. Providers should ensure that the patient is aware of potential out-of-pocket costs.
- Medically Necessary Procedure: If the skin tags are symptomatic, such as causing irritation, bleeding, or affecting mobility, the procedure may be considered medically necessary and covered by insurance.
2. Number of Lesions:
The number of skin tags removed directly impacts billing. If only a small number of tags are removed, the procedure may be considered a single service (CPT 11200). For larger numbers of skin tags, additional codes will be required to account for the multiple lesions treated.
3. Anesthesia:
If anesthesia is required for the procedure, it should be coded separately, using CPT codes for anesthesia services. These codes will vary based on the type of anesthesia used (local, regional, or general) and whether it is administered by a physician or another healthcare provider.
Example:
- CPT Code 99100: Used for anesthesia services requiring special circumstances.
Documentation Best Practices
Proper documentation is crucial for accurate coding and billing. Providers should ensure they document the following:
- Location and Size: Note the number, size, and location of the skin tags. This will help ensure proper coding and determine whether a higher number of tags affects the complexity of the procedure.
- Reason for Removal: Clearly document whether the removal is for cosmetic purposes or if there is a medical reason, such as irritation or risk of infection.
- Procedure Details: Detail the method of removal (e.g., excision, cryotherapy, cauterization) and the anesthesia used if applicable.
- Patient Consent: For cosmetic procedures, especially, it is important to document that the patient provided informed consent for the removal.
Accurate coding and billing for skin tags are essential for proper reimbursement and avoiding claim denials. By correctly applying ICD-10 codes for skin tag diagnosis, CPT codes for the removal procedure, and using appropriate modifiers, providers can ensure smooth reimbursement processes and compliance with insurance requirements. Detailed documentation is key, as it supports the medical necessity of the procedure, especially when billing for removal of skin tags that may be considered cosmetic in nature.
Staying up to date on coding guidelines and payer policies can further help healthcare providers navigate the complexities of billing for skin tag removal and improve overall billing accuracy.
Coding Common skin procedures AAFP https://www.aafp.org/pubs/fpm/issues/2005/1000/p47.html#:~:text=For%20removal%20of%20skin%20tags,tags%20removed%2C%20use%20code%2011200.