Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratosis), 2-14 lesions
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Lesion count outside 2-14 range - should use different code
Common17003 (destruction 2-14 premalignant lesions) requires 2-14 lesions treated. Single lesion = 17000 only. 15+ lesions = add 17004. Denied when lesion count doesn't match code. Must document exact number and individual lesion locations.
Common Causes
- • Only 1 lesion destroyed - should bill 17000, not 17003
- • 18 lesions destroyed - should bill 17003 (covers first 14) + 17004 (15+)
- • Number of lesions not documented - payer assumes single lesion 17000
Resolution Strategy
Document lesion count and locations: 'Cryotherapy to 11 actinic keratoses: 3 on forehead, 2 on right temple, 4 on nose, 2 on left cheek. Each lesion treated with liquid nitrogen until adequate freeze achieved.' If 1 lesion, bill 17000 only. If 2-14, bill 17003. If 15+, bill 17003 + 17004. Cannot appeal without documented lesion count ≥2.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Destruction of 2-14 additional premalignant lesions using various methods
Common Scenarios
Documentation Requirements
- Number of additional lesions documented (2-14)
- Location of lesions documented
- Method of destruction documented
- Patient response to treatment
Coding Guidelines
Common Modifiers
Bundling Rules
- 2-14 additional lesions
- Must be preceded by 17000
- Various destruction methods
Exclusions
- Do not bill as first lesion (use 17000)
- Do not bill if 15+ additional (use 17004)
Coding Notes
Clinical scenarios
- Number of additional lesions documented (2-14)
- Location of lesions documented
- Method of destruction documented
- Number of additional lesions documented (2-14)
- Location of lesions documented
- Method of destruction documented
- Number of additional lesions documented (2-14)
- Location of lesions documented
- Method of destruction documented
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 17003 is the billing code for "Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratosis), 2-14 lesions". Destruction of 2-14 additional premalignant lesions using various methods
Medicare pays approximately $6.47 for CPT 17003 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 17003 has a total RVU of 2.28, broken down as: Work RVU 1.00, Practice Expense RVU 1.20, and Malpractice RVU 0.08. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 17003 is "Lesion count outside 2-14 range - should use different code". 17003 (destruction 2-14 premalignant lesions) requires 2-14 lesions treated. Single lesion = 17000 only. 15+ lesions = add 17004. Denied when lesion count doesn't match code. Must document exact number and individual lesion locations. Common causes include: Only 1 lesion destroyed - should bill 17000, not 17003; 18 lesions destroyed - should bill 17003 (covers first 14) + 17004 (15+). Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 17003 include: Number of additional lesions documented (2-14); Location of lesions documented; Method of destruction documented; Patient response to treatment. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 17003: 2-14 additional lesions. Must be preceded by 17000 Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 17003 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 17003 is Typically 15-30 minutes. Time-based codes require documentation of the actual time spent providing the service.