CPCA Coding for Laser Treatments 5 — Questions and Answers
Question 1: A payer applies the National Correct Coding Initiative (NCCI) edits and denies a claim pairing 17000 with 17110. Why?
- Both are bilateral procedure codes
- 17000 and 17110 are mutually exclusive — only one destruction method is reported per session
- NCCI bundles all destruction codes under 17000 regardless of lesion type
- Modifier 59 is required on 17110 to bypass the edit (Correct answer)
Correct answer: Modifier 59 is required on 17110 to bypass the edit
NCCI edits pair 17000 (premalignant lesion) and 17110 (benign lesion) as a column 1/column 2 edit, but modifier 59 (distinct procedural service) on 17110 can override the edit when truly separate lesions of different types are treated.
Question 2: Laser trabeculoplasty for open-angle glaucoma is coded from which CPT code range?
- 65850–65865 (Correct answer)
- 67140–67145
- 92081–92083
- 66170–66175
Correct answer: 65850–65865
CPT 65855 (Trabeculoplasty by laser surgery) reports laser trabeculoplasty for glaucoma and falls in the 65850–65865 range of ophthalmology procedure codes.
Question 3: Which of the following laser procedures is reported with CPT 67228 (Treatment of extensive or progressive retinopathy)?
- Scatter laser photocoagulation for diabetic retinopathy (Correct answer)
- Laser treatment for macular degeneration
- Laser iridotomy for narrow-angle glaucoma
- Laser cyclophotocoagulation for refractory glaucoma
Correct answer: Scatter laser photocoagulation for diabetic retinopathy
CPT 67228 reports laser photocoagulation for extensive or progressive diabetic or other retinopathy, commonly referred to as panretinal photocoagulation (PRP).
Question 4: A surgeon performs laser ablation of the endometrium. Which CPT code is reported?
- 58563 (Correct answer)
- 58541
- 57520
- 58670
Correct answer: 58563
CPT 58563 reports hysteroscopy with endometrial ablation (includes laser ablation), capturing the laser-based destruction of endometrial tissue performed via hysteroscope.
Question 5: When a laser procedure note documents the lesion size before and after treatment, which measurement determines the CPT code selection for skin destruction?
- Pre-treatment lesion diameter (Correct answer)
- Post-treatment defect size
- The largest dimension regardless of timing
- Mean of pre- and post-treatment sizes
Correct answer: Pre-treatment lesion diameter
CPT guidelines specify that the size of the lesion—measured before excision or destruction—determines code selection; the post-procedure defect may be larger and should not be used.
Question 6: A practice bills CPT 17110 for destruction of 16 seborrheic keratoses. The claim is audited and downcoded. What likely error occurred?
- 17110 requires modifier 22 for more than 14 lesions
- 17111 should have been used because 15 or more benign lesions were destroyed (Correct answer)
- 17004 is required when 15+ lesions of any type are destroyed
- The coder should have reported 17110 x 2 units
Correct answer: 17111 should have been used because 15 or more benign lesions were destroyed
CPT 17110 covers up to 14 benign lesions; when 15 or more are destroyed in one session, CPT 17111 is the correct code and 17110 should not be reported.
Question 7: Which modifier is used when the same laser destruction procedure is performed by the same physician in two separate sessions on the same day?
- Modifier 22
- Modifier 76 (Correct answer)
- Modifier 59
- Modifier 78
Correct answer: Modifier 76
Modifier 76 (Repeat Procedure or Service by Same Physician) is appended to the second claim when the same physician performs the identical procedure more than once on the same date of service.
CPCA Coding for Laser Treatments 5
A payer applies the National Correct Coding Initiative (NCCI) edits and denies a claim pairing 17000 with 17110.
Why?