UCR 157: Chronic Care Management reimbursement; coding for scrotal lesion excisions

August 11, 2023 

Ray, Mark, and Scott discuss 2 questions that came into the Urology Coding and Reimbursement Group (see below for a link to sign up free):

Good Evening 
Our office is looking into Chronic Care Management. We know that CCM requires the patient to have 2 chronic conditions. Most of these patients have prostate cancer and diabetes, and or hypertension. Which brings me to my question our providers will be treating and managing the cancer but as for as the diabetes goes they are not treating this or managing it in any way. Would we still be able to use this in out CCM billing?Hi, What CPT code set would you bill for Excision Scrotal Lesion(s)? (Path Report: Benign). Would you code with 11420-11426 or 11106-11107 or 54060 or something else? NOTE DETAILS: FINDING(s): Numerous scattered superficial skin lesions, In total 20cm skin removed. "We began by marking out the areas of concern with elliptical incisions. There were numerous lesions but they were spread out enough that we decided to do multiple separate incisions. After the lesions were marked the skin was anesthetized with 0.5% Macaine. Incisions were made sharply along the previous marked ellipse. The skin was then carefully dissected sharply from of the underlying dartos tissue. Hemostasis was achieved with bipolar cautery. This was repeated for all lesions."

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