The Right Way to Code For Skin Tags and Their Removal
In order to code for skin tags and their removal, it is essential to know certain facts about these hypertrophic skin disorders, including some alternative terms. There are also corresponding ICD-10-CM and CPT coding guidelines you will need to know when assigning the correct codes. This article explains it in simple terms so that you know the right way to code for skin tags and their removal.
What Are Skin Tags?
Skin tags are common noncancerous skin growths that extend out from the skin’s surface on a piece of tissue called a stalk, or peduncle. Although typically painless, skin tags can appear anywhere on the body. They mostly occur, however, on the neck and underarms. These flesh-colored bumps start out small but may get larger and become irritated due to friction or pressure.
“Estimates are that almost 50 to 60% of adults will develop at least one skin tag in their lifetime, with the probability of their occurrence increasing after the fourth decade of life,” according to the National Center for Biotechnology Information (NCBI)/StatPearls.
A skin tag may be referred to by its medical term, acrochordon. It may also be called a soft fibroma or fibroepithelial polyp, according to Harvard Health Publishing.
Symptoms and Causes of Acrochordons
Acrochordons (skin tags) typically do not cause any symptoms, though they can become uncomfortable and bleed when they rub against the skin or clothing.
The cause of acrochordons is unclear. However, acrochordons occur when the body produces additional cells in the top layers of the skin, according to Cleveland Clinic.
Skin tags often grow in these areas:
- Armpits
- Eyelids
- Groin or thighs
- Neck
- Under the breasts
- Genitals
People who are older have an increased risk of skin tags. Additionally, diabetes, obesity, skin disorders, and hormonal changes during pregnancy can increase the chances of skin tags.
Diagnosing Skin Tags
A brief evaluation is performed to diagnose skin tags. The physician will take a medical history and determine if any conditions exist that may raise the person’s chance of developing skin tags.
An exam will help rule out other conditions that look similar to skin tags such as moles, warts, skin cancer, and skin diseases such as seborrheic keratosis.
If something other than a skin tag is suspected, the physician may perform a biopsy and have it tested.
Treatment
Skin tags are not harmful and do not need to be removed. All the same, some people may choose to have them removed because they are visually unsightly or may cause friction.
Treatment is often performed in a dermatologist’s office and may include one of several different procedures:
- Surgical excision: scissors or a scalpel is used to cut it off
- Electrocautery: electric probe or needle is used to burn it off by delivering heat
- Carbon dioxide (CO2) laser therapy: light-based energy is used to excise it
- Cryosurgery (also known as cryotherapy or cryoablation): liquid nitrogen is used to freeze it off
- Ligation: surgical thread is wrapped around the neck of the tag to cut off blood flow
- Shave excision: local anesthetics are injected at the base of the tag before shaving it off
- Radiocautery: radio waves are used to burn it off
The above procedures are not usually covered by insurance since they are considered cosmetic.
The following short video (less than 2 minutes long) demonstrates the removal of skin tags.
ICD-10-CM Coding
The code for skin tags can be found in the ICD-10-CM coding manual in Chapter 12: Diseases of Skin and Subcutaneous Tissue. Specifically, it is located in the subchapter called Other disorders of the skin and subcutaneous tissue (L80-L99).
To find the code in the Alphabetic Index, look up Tag (hypertrophied skin) (infected)/skin, L91.8. In the Tabular List, we can verify the correct code as:
L91.8, Other hypertrophic disorders of the skin
A skin tag is a hypertrophic disorder of the skin. Hypertrophic means exhibiting hypertrophy. Hypertrophy is defined as an enlargement or overgrowth of an organ or part of the body due to the increased size of the constituent cells, according to MedicineNet.
CPT Coding for Skin Tag Removal
The removal of skin tags is reported with CPT codes from:
- Section: Surgery
- Subsection: Integumentary System
- Subheading: Subcutaneous and Accessory Structures
- Category: Removal of Skin Tags Procedures
- Subcategory: Removal of skin tags, multiple fibrocutaneous tags, any area
To find the code for removal of skin tags in CPT, go to the Alphabetic Index and look up Removal/skin tags, 11200-11201. In the Tabular List, we can verify these two codes as:
11200, Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
11201, Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure)
If you do not know what fibrocutaneous means:
Fibr/o means fibrous tissue. Cutaneous means pertaining to the skin; cutane means skin; -ous means pertaining to.
As you can see from the code descriptions, codes 11200 and 11201 are based on the number of tags removed. For example, if 1 through 15 skin tags are removed, report code 11200. If more than 15 and 25 or less skin tags are removed, report 11200 and 11201 as an add-on code.
CPT code 11200 is always sequenced first, and code 11201 is never reported alone.
According to the CPT coding guidelines, these codes are reported when skin tag removal is performed by scissoring or any sharp method, ligature strangulation, electrosurgical destruction or combination of treatment modalities, including chemical destruction or electrocauterization of wound, with or without local anesthesia.
Coding Exercises
Based on what you have learned above, assign the correct CPT code(s) for the following:
- 15 skin tags are removed.
- Removal of 30 skin tags by electrocautery.
- 7 fibroepithelial polyps are removed using shave excision.
Now, assign for CPT and ICD-10-CM:
- A 52-year-old female reports to the clinic with multiple skin tags. There are 19 skin tags in the regions surrounding her neck and axilla. The patient requests for the skin tags to be removed. Cryosurgery is used to remove them.
Answers
CPT:
- 11200
- 11200, 11201, 11201
- 11200
CPT and ICD-10-CM:
- CPT: 11200, 11201; ICD-10-CM: L91.8
Remember:
- A skin tag may be referred to by another name, such as an acrochordon, soft fibroma, or fibroepithelial polyp. It is still a skin tag.
- The procedure used to remove a skin tag may include scissoring or any sharp method, ligature strangulation, electrosurgical destruction or combination of treatment modalities, including chemical destruction or electrocauterization of wound, with or without local anesthesia is reported with CPT codes 11200 and 11201 (add-on). Therefore, the examples above specifying electrocautery, shave excision, and cryotherapy as the procedure used to remove the skin tags are all covered by codes 11200 and 11201.
