Treatment of acne usually consists of a good skin care regimen including the use of benzoyl peroxide, antibiotics, and retinoids. However, surgical treatment of acne can be performed depending on the severity of the lesions. Treatment of acne includes the following:
Surgical Treatment of Acne (706.1)
- Marsupialization, opening, expression, or removal of comedones, milia and pustules - This service is eligible and should be reported with code 10040.
- Incision and drainage of true cysts - This service is eligible and should be reported with codes 10060 or 10061.
- Laser treatment of active acne - This treatment is considered experimental. Scientific evidence does not demonstrate the efficacy of using lasers to treat acne. Participating, preferred, and network providers can bill the member for the denied service. Laser treatment should be reported with codes 17110-17111.
Date Last Reviewed - 01/2007
If surgical treatment of acne (code 10040) is reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care. Payment for medical care performed on the same date of service includes the allowance for the surgical treatment of acne. A participating, preferred, or network provider cannot bill the member separately for the surgical treatment of acne in this case.
If the surgical treatment of acne is performed independently, process it under the appropriate code(s).
Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the surgical treatment of acne. When the 25 modifier is reported, the patient's records must clearly document that separately identifiable medical care has been rendered.
Photodynamic Therapy for Acne (706.1)
Photodynamic therapy (96567), with topical aminolevulinic acid (ALA), code J7308, and exposure to blue or red light is considered investigational for acne vulgaris. Participating, preferred, and network providers can bill the member for the denied service.
Date Last Reviewed - 02/2007
Medical Treatment of Acne (706.1)
Medical visits for the treatment of acne are covered under the appropriate Evaluation and Management service. Coverage for medical visits is determined according to individual or group customer benefits.
Post acne surgery will be processed in accordance with the guidelines on cosmetic/reconstructive surgery (Medical Policy Bulletin S-28).
Description
Acne is a common, inflammatory disease of the sebaceous glands characterized by comedones, papules, pustules, inflamed nodules, and superficial pus-filled cysts. Acne occurs when sebum blocks the sebaceous glands and adjacent hair follicles. This blockage allows bacteria to multiply and inflame the blocked hair follicle.
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