17000

Destruction of Premalignant Lesion, First Lesion

CPT code 17000 describes the destruction of a single premalignant lesion using any of several recognized techniques, including cryosurgery, electrosurgery, laser surgery, chemosurgery, or surgical curettement. Premalignant lesions, most commonly actinic keratoses (AKs), are atypical skin growths that have the potential to transform into invasive squamous cell carcinoma if left untreated. These lesions typically result from cumulative ultraviolet (UV) radiation exposure and are frequently located on sun-exposed anatomical sites such as the face, scalp, dorsal forearms, and ears. During cryosurgery, the most common modality, the clinician applies liquid nitrogen to the lesion, creating a localized freeze that causes thermal shock and cellular necrosis of the dysplastic keratinocytes. Electrosurgery involves the use of high-frequency electric current to desiccate or fulgurate the lesion, while laser surgery utilizes specific wavelengths of light to vaporize target tissue. Surgical curettement involves scraping the lesion with a sharp curette, often followed by electrodesiccation to ensure hemostasis and complete removal of abnormal cells. The procedure is usually performed in an outpatient setting. Accurate reporting of this code requires documentation of the clinical diagnosis as premalignant and a description of the method used. CPT 17000 is specific to the first lesion treated during a clinical encounter. If multiple lesions are treated, this code serves as the primary code for the initial lesion, while add-on codes or alternative codes are used for additional quantities, depending on the total count.

Clinical Indications

  • Actinic keratosis (AK)
  • Bowenoid papulosis
  • Cutaneous horn with underlying premalignancy
  • Other specified premalignant skin lesions
  • Carcinoma in situ of the skin (e.g., Bowen's disease) when destruction is the chosen modality

Procedure Steps

  1. Identify and mark the premalignant lesion(s) for destruction.
  2. Clean the treatment area with an antiseptic solution such as alcohol or chlorhexidine.
  3. Administer local anesthesia (e.g., 1% lidocaine) if performing curettage or if the lesion is large or in a sensitive area.
  4. Perform destruction using the chosen modality (e.g., application of liquid nitrogen via spray or probe, use of a CO2 laser, or application of a chemical agent).
  5. If using surgical curettage, scrape the lesion until a firm dermal base is reached, potentially followed by electrodesiccation.
  6. Inspect the treated area to ensure the entire lesion has been addressed and achieve hemostasis if necessary.
  7. Apply a topical antibiotic ointment or petroleum jelly and a dressing if indicated.
  8. Provide the patient with post-procedure wound care instructions.

Coding Guidelines

  • Report 17000 for the destruction of the first premalignant lesion only.
  • For lesions 2 through 14, use add-on code 17003 for each additional lesion in conjunction with 17000.
  • If 15 or more lesions are treated, do not report 17000 or 17003; instead, report only code 17004, which covers the entire treatment of 15 or more lesions.
  • Destruction includes any method (laser, cryosurgery, etc.); the choice of technique does not change the CPT code.
  • Do not use 17000 for benign lesions (e.g., common warts, seborrheic keratoses); refer to 17110-17111 for those services.
  • Simple wound care and local anesthesia are included in the global surgical package for this procedure.
  • If a biopsy is performed on the same lesion prior to destruction because the diagnosis was unknown, the biopsy (11102) may be reported with modifier 59.

Associated ICD-10 Codes