Histofreezer® CPT Codes

As a service to our physicians and their staff, STC Technologies is pleased to provide information that we hope will assist you in billing and reimbursement for cryosurgical procedures performed using the Histofreezer® Portable Cryosurgical System.

Information provided is for example and comparison only. It does not represent a guarantee or assurance that services will be considered or paid.

Following is information on:

Recommended CPT Codes
Explanation of Reimbursement methods for:

• Medicare
• HMO's
• Private Insurers

RECOMMENDED CPT CODES
For billing and reimbursement purposes, it is recommended that the following Common Procedure Terminology (CPT) codes, as provided by the American Medical Association, be used: (Refer to Integumentary System-Destruction Benign or Premalignant Lesions).

Code Recommendation For:

• Verruca Vulgaris
• Verruca Plantaris
• Actinic Keratosis
• Lentigo
• Seborrheic Keratosis

17000 - Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion.

17003 - second through 14 lesions, each (List separately in addition to code for first lesion)

17004 - 15 or more lesions

Code recommendation for Molluscum Contagiosum and Verruca Plana:

17110 - Destruction by any method of flat warts, molluscum contagiosum, or milia up to 14 lesions

17111 - 15 or more lesions

Code recommendation for Skin Tags (Acrochordon):

11200 - Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

11201 - each additional ten lesions

Code Recommendation for Condylomata Acuminata & Molluscum Contagiosum (Refer to Digestive System-Anus Destruction, Male Genital System-Penis Destruction, and Female Genital System-Vulva, Perineum and Introitus Destruction):

46916 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery

46924 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive; any method

54056 - Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery

54065 - Destruction of lesion(s), penis (eg, condyloma papilloma, molluscum contagiosum, herpetic vesicle), extensive; any method

56501 - Destruction of lesion(s), vulva; simple, any method

56515 - Extensive; any method

It is important to note that appropriate diagnosis codes must be submitted to substantiate medical necessity for the procedure. Additionally, the appropriate modifer code must also accompany the respective CPT code to insure payment where multiple lesions or second applications may occur. Finally, adequate documentation of the procedure performed should be contained in the patient's chart to substantiate the service billed.

The following is a list of modifer codes that may be used in conjunction with CPT code submission.

We recommend that offices billing these procedures for the first time direct questions to their carrier representatives.

REPORTING PROCEDURES
Reporting procedure described by codes 17000-17004 varies from carrier to carrier, and in many cases is left up to the physician to interpret. The following examples of reporting methods are for illustration purposes only and should not be assumed to be acceptable to all carriers, but should be applicable in most circumstances.

Following is an example of one common method for reporting these procedures to most common carriers:

REIMBURSEMENT RANGES
Our research shows that the average ranges for reimbursement in 1997 for the Histofreezer® system across the United States are:

*Payments varied depending on whether charges were submitted on a per lesion or flat fee basis and vary from state-to-state.

MEDICARE REIMBURSEMENT
The 17000 series for destruction of skin lesion codes has been adopted by HCFA and should be utilized as of January 1, 1998.

HEALTH MAINTENANCE ORGANIZATION (HMO) REIMBURSEMENT
Cryosurgery is a covered service by most HMO's. Basically, there are two formats for HMO service providers:

1. Group Practice, in which patients receive all care from one group practice with only super-specialty care being referred out of the practice. Typically, physicians in this format are employed full-time by the HMO and have no fee-for-service practice. In this case, the service is covered under the standard capitation payments.

2. Independent/Individual Practice Association (IPA), in which the primary care practitioner acts as the "gatekeeper" for all care rendered to a given patient, requiring written referral to a specialist outside the practice (preferably a plan participant). Generally, the physician and practice association share in a "capitation" payment designed to cover all care. The association pays specialists from a "pool" and withholds a "risk incentive", a percentage of which is paid, by the formula, to the participating specialists at the end of the year based on plan utilization.

For simple cryosurgery procedures, such as wart removal using the Histofreezer® system, the primary care IPA physician will often treat the patient under the standard capitation, rather than refer to a specialist who is paid out of the risk pool. In many cases, the balance of the risk incentive pool at year-end is shared between the primary care physicians and specialists. Although procedure-specific reimbursement may not be available to the primary care physician, it may be financially preferable to treat the patient under standard capitation, rather than dip into the risk pool to pay a specialist.

PRIVATE INSURERS AND BLUE SHIELD
Most of these types of third party insurers pay claims based on a set fee schedule by procedure code, although Blue Shield plans may use "Usual, Customary, and Reasonable" (UCR) reimbursement screens which are based on profile analyses. Plan participating physicians receiving UCR payments directly from the insurer are required to accept the plan allowed amounts as payment in full. Participating physicians can usually access reimbursement information from the insurer using their provider numbers. Non-participating physicians are not required to accept UCR levels.

STC Technologies does not guarantee reimbursement levels or that codes will be considered when submitted.