CPT Code 11900 Intralesional Injection | Billing, Reimbursement & Modifiers
What Does CPT Code 11900 Describe?
CPT code 11900 is used for intralesional injections of medication into up to 7 skin lesions, such as warts, psoriasis, acne cysts, keloids, and other skin conditions. This procedure involves injecting therapeutic substances, including steroids and chemotherapy agents, directly into the lesions.
When is CPT Code 11901 Used Instead?
If more than 7 skin lesions are treated during a session, CPT code 11901 should be used. This code applies to procedures involving the injection of medication into a greater number of lesions.
What Should Be Included in Documentation for CPT Code 11900?
Documentation for CPT code 11900 should include the following key elements to support accurate billing and reimbursement:
- The exact number of lesions treated, which must be up to and including 7.
- The types of lesions injected (for example, cystic, nodular, keloid, psoriasis, acne, warts).
- The specific location of each injected lesion.
- Description of the medication injected (such as corticosteroids or chemotherapy agents).
- Details about the procedure, including the injection technique and substances used.
- Any related evaluation and management (E/M) services provided on the same day, with justification if a modifier 25 is used.
- Documentation of any modifiers applied (e.g., 59 for a distinct procedural service or 51 for multiple procedures).
- Accurate recording of dosage if a drug is billed separately with J-codes.
Clear and thorough documentation of these details is crucial to prevent claim denials, ensure accurate coding (especially between 11900 and 11901), and maximize reimbursement for intralesional injection procedures.
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Where is CPT Code 11900 Typically Used?
CPT code 11900 is typically used in medical specialties focusing on dermatology and surgical procedures on the integumentary system. It is commonly utilized in:
Dermatology practices for treating skin conditions such as warts, cysts, acne, keloids, psoriasis, scars, and other lesions.
Outpatient and office settings where intralesional injections are performed.
Clinics performing minor skin procedures requiring therapeutic injections directly into lesions.
Surgical specialties addressing superficial skin lesions requiring corticosteroid or other medication injections.
This code is mainly associated with moderate-complexity surgical procedures involving the skin and soft tissue, often performed in outpatient clinics, physician offices, and occasionally in hospital outpatient departments.
How is CPT Code 11900 Reimbursed?
CPT code 11900 reimbursement is generally based on Medicare fee schedules and varies by payer, geographic location, and place of service. It covers the intralesional injection procedure for up to 7 lesions. Key points about reimbursement include:
Average national Medicare reimbursement for CPT 11900 typically ranges from approximately $60 to $90, depending on locality and office versus facility settings.
Private payer rates may vary, sometimes higher or lower, influenced by contracts and negotiated rates.
Reimbursement covers only the injection procedure; injectable drugs administered are billed separately with appropriate HCPCS or J-codes.
Modifiers such as 59 (distinct procedural service) or 51 (multiple procedures) may influence reimbursement if applicable.
Providers must document lesion count, injection sites, and medications to support claims.
Fee schedules differ state by state, sometimes noticeably, reflecting local wage and cost indices.
Do I Need Separate Billing for the Medication?
Yes, you need to bill separately for the medication administered during the intralesional injections covered by CPT code 11900. CPT 11900 only covers the procedure of injecting medication into up to 7 skin lesions; it does not include the cost of the medication itself.
The medication, such as a corticosteroid like Kenalog (triamcinolone acetonide), should be billed separately using the appropriate HCPCS or J-codes that describe the specific drug and dosage administered.
For example, if Kenalog is used, you might bill J3301 based on the amount of drug used. Additionally, the facility (e.g., outpatient hospital or ambulatory surgical center) typically bills separately for the medication if they purchase it for the procedure.
Proper documentation of the medication type, dosage, and units used is crucial to support accurate billing and reimbursement.
What is CPT Code 11901 Used For?
CPT code 11901 is used for intralesional injections of medication into more than seven skin lesions in the same session. This code is the counterpart to CPT 11900, which covers injections into up to and including seven lesions.
These codes are commonly used in dermatology to treat conditions like warts, keloids, cysts, psoriasis, and other skin lesions where medication is injected directly into the lesions.
What is the Difference Between CPT Codes 11900 and 11901 in Billing?
| Aspect | CPT 11900 | CPT 11901 |
|---|---|---|
| Description | Intralesional injection into up to 7 lesions | Intralesional injection into more than 7 lesions |
| Number of Lesions Covered | 1 to 7 lesions | More than 7 lesions |
| Procedure Reporting | Report once regardless of how many injections per lesion | Report once for the session when >7 lesions treated |
| Add-on Code Status | Not an add-on code | Not an add-on code |
| Documentation | Must document lesion type, count, and location | Must document lesion type, count (above 7), and location |
| Clinical Use | Used mainly for localized dermatologic injections | Used when extensive lesion treatment is present |
| Modifiers Commonly Used | Modifier -59 (distinct procedure), Modifier -51 (multiple procedures) | Same as 11900 |
| Reimbursement Differences | May vary; typically reimbursed for fewer lesions | May have higher reimbursement reflecting higher burden |
| Billing Practice | Only one of these codes is billed per session | Cannot be billed together with 11900 on the same day |
| Coding Clarifications | Ensures no overcoding for multiple lesion injections under 7 | Covers cases with lesion counts above 7 |
Can Both Codes Be Used Together?
No, these codes cannot be used together for the same session. Only one code should be selected based on the number of lesions treated during the procedure. If a patient receives injections into 7 or fewer lesions, CPT 11900 applies. For 8 or more lesions, CPT 11901 must be billed.
Does CPT Code 11900 Cover the Cost of Medication?
CPT code 11900 does NOT cover the cost of medication. It only covers the procedure of injecting medication into up to 7 skin lesions. The medication itself must be billed separately using appropriate drug codes such as HCPCS or J-codes (for example, J3301 for Kenalog/triamcinolone).
What are the acceptable modifiers with cpt code 11900
Acceptable modifiers with CPT code 11900 include:
Modifier 25: Significant, separately identifiable evaluation and management (E/M) service performed on the same day as the procedure.
Modifier 50: Bilateral procedure, used if injections are performed on bilateral lesions.
Modifier 51: Multiple procedures performed at the same session by the same provider.
Modifier 59: Distinct procedural service, to indicate a procedure separate from others performed same day.
Modifier LT: Injection performed on the left side of the body.
Modifier RT: Injection performed on the right side of the body.
Modifier 76: Repeat procedure or service by the same provider on the same day.
Modifier 77: Repeat procedure by a different provider on the same day.
Modifier 78: Unplanned return to the operating room for related procedure during postoperative period.
Modifier 79: Unrelated procedure or service by the same provider during postoperative period.
These modifiers help clarify the circumstances of the procedure, prevent denials, and support proper reimbursement when billing CPT 11900.
Can Modifiers Impact Reimbursement?
Yes, modifiers can impact reimbursement for CPT code 11900 by providing additional information about the circumstances of the service performed, which helps ensure accurate billing and appropriate payment. Commonly used modifiers with 11900 include:
Modifier 25: Indicates a significant, separately identifiable Evaluation and Management (E/M) service was provided on the same day as the injection.
Modifier 59: Denotes a distinct procedural service performed on the same day as another procedure.
Modifier 51: Applied when multiple procedures are performed during the same session.
Modifiers for laterality: LT (left side) and RT (right side).
Repeat procedure modifiers like 76 (same provider) and 77 (different provider).
Why is Documentation Important When Using Modifiers with CPT 11900?
The use of these modifiers must be supported by appropriate documentation to justify the need for separate reimbursement or to explain the circumstances of the procedures. This is especially important when multiple procedures or significant E/M services are provided on the same day, ensuring proper billing.
Are Modifiers for the Injected Medication Billed with CPT 11900?
Modifiers related to the injected medication, such as J-codes for injectable drugs, are billed separately and are not included with CPT code 11900 itself. These codes are for the medication component and need to be billed using the appropriate injection or drug code.
What is the Global Period for CPT Code 11900?
The global period for CPT code 11900, which covers intralesional injections into up to and including seven skin lesions, is typically 0 days. This means that there is no global period associated with this procedure according to Medicare and major payer guidelines.
What Does a 0-Day Global Period Mean for Billing?
A 0-day global period means that routine postoperative care related to the procedure is not included in a bundled global surgical package. As a result, providers can bill for separate evaluation and management (E/M) services on the same day as the procedure if medically necessary, without requiring modifiers or concerns about unbundling.
Are There Any Other Global Periods for Similar Procedures?
Some sources may mention a 10-day global period for minor dermatology procedures in general. However, CPT 11900 specifically has an official global period designation of 0 days, meaning no bundled follow-up period restricts the billing of additional services.
How Does the 0-Day Global Period Affect Billing for Other Services?
In practical terms, the 0-day global period allows providers to bill for evaluation, management, or other distinct services on the same day as the intralesional injection, without concerns about unbundling or denials related to global surgical packages. This offers more flexibility when other services are needed during the same visit.
ICD-10 Codes Used with CPT Code 11900
How Do ICD-10 Codes Relate to CPT Code 11900?
ICD-10 codes relate to CPT code 11900 by providing the diagnostic justification for the procedure. Specifically, the ICD-10 code documents the skin condition or lesion type being treated by the intralesional injection represented by CPT 11900. Accurate pairing of an ICD-10 diagnosis code with CPT 11900 is essential for medical necessity validation and payer reimbursement.
Common ICD-10 Codes Used with CPT Code 11900:
Some of the most commonly used ICD-10 codes with CPT 11900 include:
B07.9: Viral warts, unspecified
L40.0: Psoriasis vulgaris
L70.0: Acne vulgaris
L91.0: Hypertrophic scar
L91.8: Other hypertrophic disorders of skin
D22.9: Melanocytic nevi, unspecified
C44.90: Skin cancer, unspecified