Below is a guide to ICD-10 codes, CPT codes, and billing modalities commonly used for Hidradenitis Suppurativa (HS) in a medical practice. It also includes suggested use cases, codes for treatments, and time-based considerations.
ICD-10 Codes for Hidradenitis Suppurativa
Hidradenitis Suppurativa is classified under L73.2.
Common Comorbidities and Secondary Diagnoses:
- Obesity: E66.9
- Diabetes mellitus type 2: E11.9
- Depression: F32.9
- Chronic pain: G89.29
- Anemia: D50.9 (if associated)
- Infection of skin/soft tissue: L08.9
- Scarring: L90.5 (Cicatricial scarring)
CPT Codes for Hidradenitis Suppurativa Services
1. Office Visits
- New Patient:
- 99202 (15-29 minutes)
- 99203 (30-44 minutes)
- 99204 (45-59 minutes)
- 99205 (60-74 minutes)
- Established Patient:
- 99212 (10-19 minutes)
- 99213 (20-29 minutes)
- 99214 (30-39 minutes)
- 99215 (40-54 minutes)
2. Medical Treatments
- Biologic Administration:
- Adalimumab (Humira): J0135 (Injection, per 20 mg)
- Typically billed along with 96401 (Administration of subcutaneous injection).
- Adalimumab (Humira): J0135 (Injection, per 20 mg)
- Antibiotic Therapy:
- Doxycycline, oral: Use as part of E/M (Evaluation and Management) services.
- Injection for abscess or secondary bacterial infection:
- J0690 (Injection, ceftriaxone, 250 mg)
- Incision and Drainage:
- 10060 (I&D of abscess, simple/single)
- 10061 (I&D of abscess, complicated/multiple)
- 10140 (I&D of hematoma or seroma)
3. Laser or Surgical Treatments
- Laser Therapy:
- 17999 (Unlisted procedure, skin/mucous membrane) – CO2 laser for HS sinus tracts (requires documentation for reimbursement).
- Excision of Lesions:
- 11400–11446 (Excision of benign lesions based on size and location).
- 11600–11646 (Excision of malignant or suspicious lesions).
4. Pain Management
- Injection of Pain Relievers:
- 64450 (Injection for nerve block or pain management for localized areas).
- Trigger Point Injections:
- 20552 (Single or multiple trigger points for up to 2 muscles).
- 20553 (Trigger points for 3 or more muscles).
5. Psychosocial and Adjunctive Services
- Mental Health Screening and Counseling:
- 96127 (Brief emotional/behavioral assessment, e.g., depression screening).
- Nutritional Counseling:
- 97802 (Medical nutrition therapy, initial assessment, 15 minutes).
- 97803 (Follow-up assessment).
Billing Modalities
- E/M and Procedure Bundling:
- If a procedure (e.g., incision and drainage) is performed during the same visit as an E/M service, append modifier -25 to the E/M code.
- Chronic Care Management (CCM):
- For patients with severe HS requiring ongoing multidisciplinary care:
- 99490 (20 minutes of non-face-to-face care management per month).
- 99487 (Complex CCM requiring 60 minutes of clinical staff time).
- For patients with severe HS requiring ongoing multidisciplinary care:
- Telemedicine Codes:
- 99441–99443: Telephone E/M services.
- G2010: Remote evaluation of recorded patient video/images.
- Photographic Documentation:
- Use documentation to justify coding severity and progression for surgical or laser treatments.
Documentation Tips for Maximum Reimbursement
- Clearly document:
- Hurley stage and severity of HS.
- Comorbid conditions.
- Specific treatments and their indications.
- Time spent on patient care (if using time-based codes).
- Justify the medical necessity for biologics, advanced therapies, or surgical interventions.
- Use detailed descriptions for procedures, especially when using unlisted codes (e.g., laser therapy).
Example Billing Scenarios
- Moderate HS Requiring Biologic Therapy:
- ICD-10: L73.2, E66.9
- CPT: 99214 (office visit), J0135 (Humira, per 20 mg), 96401 (injection administration).
- Severe HS with Incision and Drainage:
- ICD-10: L73.2, L08.9
- CPT: 10061 (complicated I&D), 99213-25 (office visit).
- Laser Therapy for Advanced Disease:
- ICD-10: L73.2, L90.5
- CPT: 17999 (CO2 laser procedure).
- Chronic Care Management:
- ICD-10: L73.2, E11.9, F32.9
- CPT: 99490 (CCM, 20 minutes).
This approach ensures comprehensive care and accurate billing while supporting insurance reimbursement. Always consult specific payer policies to confirm coding details.
