CPT Codes for Skin Tag Removal Explained

Dermatologists regularly carry out skin tag removals for reasons of appearance or health. It is important that healthcare providers and patients learn the right codes for these medical procedures. To ensure both accuracy in what is paid by insurance and every doctor uses the same procedures, CPT codes are issued for every medical procedure. In this article, we will go through the CPT codes for skin tag removal, looking at their significance, how they are employed, and the correct documentation.

CPT Codes for Skin Tag Removal

Generally, CPT codes used for skin tag removal are specified by one of the following:

11200 – Removal of Skin Tags (Up to and Including 15 Lesions)

CPT code 11200 is used for the removal of skin tags, including up to 15 lesions. This code covers various methods of skin tag removal and includes the physician’s work, which encompasses preparing the lesion area, removing the skin tags, and performing any necessary post-procedure care. This code applies when the total number of lesions removed is 15 or fewer.

11201 – Removal of Additional Skin Tags (Each Additional 10 Lesions)

For cases where more than 15 skin tags are removed, the 11201 code is used. It is applicable for every additional 10 skin tags removed. This means if a patient requires the removal of more than 15 skin tags, the initial 15 are billed under 11200, and subsequent skin tags are billed under 11201 in sets of 10.

Skin Tag Removal Procedure Explained

Skin tags are benign growths that appear on the skin’s surface, typically in areas of friction, such as the neck, armpits, groin, and eyelids. They are usually small, soft, and may vary in color. While skin tags are generally harmless, they can cause irritation or discomfort if they rub against clothing or jewelry.

Methods of Skin Tag Removal

There are several methods that doctors use to remove skin tags, and the choice of method often depends on the size, location, and number of lesions. The most common removal methods include:

• Scissors/Snipping: This technique involves using sterilized scissors to cut the skin tag off at the base. This method is quick and usually performed under local anesthesia.
  
• Cauterization: In this process, the skin tag is burned off using a cauterizing device. This helps prevent bleeding by sealing the blood vessels.
  
• Cryotherapy: Cryotherapy involves freezing the skin tag with liquid nitrogen, causing it to fall off after a short period.

When Is Skin Tag Removal Medically Necessary?

Skin tag removal is typically considered a cosmetic procedure, but in some cases, it may be deemed medically necessary. This can occur when a skin tag causes symptoms such as:

• Irritation: Skin tags located in areas of friction (e.g., underarms, neck) may cause frequent irritation or chafing.
  
• Bleeding: Skin tags can become irritated and start bleeding if they catch on clothing or jewelry.
  
• Pain: In certain cases, particularly with larger skin tags, they can become painful, especially if they are continuously irritated.

Medical Necessity & Documentation Requirements

To have a skin tag removal procedure deemed medically necessary, healthcare providers must thoroughly document the patient’s condition. Insurance companies often require clear evidence of symptoms such as bleeding, pain, or irritation. In some cases, the presence of a skin tag in a high-friction area or a recurring infection might support the medical necessity of removal.

ICD-10 Codes Supporting Medical Necessity

Certain ICD-10 codes can help substantiate the medical necessity for skin tag removal. These codes describe conditions associated with skin tags or related complications. One of the most commonly used codes for skin tag removal is:

• L91.8 – Other Hypertrophic Skin Conditions: This ICD-10 code is used for various skin conditions, including skin tags, which fall under hypertrophic lesions.
  

Billing & Coding Guidelines

Correctly Medical coding and billing for skin tag removal is essential to ensure proper reimbursement. Healthcare providers must follow the established guidelines for CPT codes 11200 and 11201, ensuring that they are used correctly based on the number of lesions being removed. Documentation should clearly indicate the number of skin tags, the removal method, and whether the procedure was medically necessary or cosmetic.

Correct Use of CPT 11200 vs. 11201

It is crucial to use 11200 for the removal of up to 15 skin tags, and 11201 for every additional set of 10 lesions. For example, if a patient requires the removal of 25 skin tags, the billing would include 11200 for the first 15 and 11201 for the additional 10.

Modifiers (If Applicable)

In some cases, modifiers may be necessary for specific situations. Modifiers are two-digit codes that can be added to the CPT code to provide additional information about the procedure. For example, modifier -59 might be used to indicate that the procedure was distinct and separate from other services provided on the same day.

Insurance Coverage Considerations

Insurance coverage for skin tag removal varies depending on the reason for the procedure. When the procedure is considered cosmetic (i.e., no medical necessity is present), insurance companies typically do not cover the cost. However, if the skin tags cause pain, bleeding, or irritation, insurance may cover the procedure. Patients should verify with their insurance provider regarding coverage, and physicians should document the clinical necessity of the procedure.

FAQs About Skin Tag Removal Coding

Can Cosmetic Removal Be Billed to Insurance?

Generally, cosmetic skin tag removal is not covered by insurance. Insurance companies typically require that the procedure be medically necessary, meaning the skin tags must cause symptoms such as pain, irritation, or bleeding. If the removal is purely for cosmetic reasons, the patient will likely need to pay out-of-pocket.

How Many Lesions Qualify for 11200 vs. 11201?

• 11200 covers the removal of up to 15 skin tags.
• 11201 applies to every additional set of 10 skin tags removed beyond the initial 15.
  

So, for example, if 22 skin tags are removed, the first 15 would be billed under 11200, and the remaining 7 would fall under 11201 (since 10 lesions are typically required for each additional code).

Conclusion

Understanding the proper CPT codes for skin tag removal and when they should be applied is essential for both healthcare providers and patients. Proper documentation and coding ensure that the procedure is reimbursed appropriately and that patients receive the necessary care. Whether the removal is for medical necessity or cosmetic reasons, it’s important to follow the correct coding guidelines to avoid billing errors and potential denials from insurance companies. By staying informed about CPT codes 11200 and 11201, and adhering to insurance requirements, both physicians and patients can navigate the skin tag removal process smoothly and efficiently.