Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratosis), 15 or more lesions
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Add-on code for 15+ lesions billed without base code 17003
Occasional17004 (destruction 15+ premalignant lesions, add-on) requires 17003 billed same session. Cannot bill 17004 alone. For 15+ lesions, bill: 17003 (covers first 14) + 17004 (covers 15+). Must document total lesion count justifying both codes.
Common Causes
- • Billed 17004 without 17003 - add-on requires base code
- • 16 lesions destroyed but only 17003 billed - need 17003 + 17004
- • Total count not documented - unclear if 15+ lesions treated
Resolution Strategy
Document 15+ lesion count: 'Extensive actinic keratoses, face and scalp. Cryotherapy to 22 lesions total: 8 forehead, 6 scalp, 4 nose, 4 cheeks. Each treated with liquid nitrogen.' Bill: 17003 (first 14 lesions) + 17004 (lesions 15-22). If <15 lesions total, bill 17003 only (drop 17004). Cannot bill 17004 without 17003 same session and documented count ≥15.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Destruction of 15 or more additional premalignant lesions using various methods
Common Scenarios
Documentation Requirements
- Number of additional lesions documented (15+)
- Location of lesions documented
- Method of destruction documented
- Patient response to treatment
Coding Guidelines
Common Modifiers
Bundling Rules
- 15+ additional lesions
- Must be preceded by 17000
- Various destruction methods
Exclusions
- Do not bill as first lesion (use 17000)
- Do not bill if 2-14 additional (use 17003)
Coding Notes
Clinical scenarios
- Number of additional lesions documented (15+)
- Location of lesions documented
- Method of destruction documented
- Number of additional lesions documented (15+)
- Location of lesions documented
- Method of destruction documented
- Number of additional lesions documented (15+)
- Location of lesions documented
- Method of destruction documented
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 17004 is the billing code for "Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratosis), 15 or more lesions". Destruction of 15 or more additional premalignant lesions using various methods
Medicare pays approximately $161.73 for CPT 17004 (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 17004 has a total RVU of 3.42, broken down as: Work RVU 1.50, Practice Expense RVU 1.80, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 17004 is "Add-on code for 15+ lesions billed without base code 17003". 17004 (destruction 15+ premalignant lesions, add-on) requires 17003 billed same session. Cannot bill 17004 alone. For 15+ lesions, bill: 17003 (covers first 14) + 17004 (covers 15+). Must document total lesion count justifying both codes. Common causes include: Billed 17004 without 17003 - add-on requires base code; 16 lesions destroyed but only 17003 billed - need 17003 + 17004. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 17004 include: Number of additional lesions documented (15+); 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 17004: 15+ additional lesions. Must be preceded by 17000 Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 17004 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 17004 is Typically 30-60 minutes. Time-based codes require documentation of the actual time spent providing the service.