Special Alert August 2025 - Benign Skin Lesion Removal Billing Guidelines

Effective immediately: Billing team must implement diagnosis code pairing requirements for all benign skin lesion removal claims submitted to Providence Health Plan. (1) For Commercial plans: Update billing system validation rules to require Group 1 diagnosis codes (single code sufficient), Group 2 diagnosis codes (both Column A AND Column B required), or Group 3 malignant diagnoses (for CPT 11300-11313 only). (2) For Medicare plans: Update system to require diagnosis codes per Providence's Medicare Local Coverage Article. (3) Audit all pending and rejected claims billed with CPT 11300-11313, 11400-11446, 17110-17111 to ensure proper diagnosis code grouping; resubmit corrected claims with appropriate diagnosis codes. (4) Train all billing and coding staff on new requirements—provide specific examples of valid diagnosis code combinations per each group. (5) Update claim submission templates and encounter forms to prompt providers to document diagnosis codes aligned with policy groups. (6) Reference the complete 'Billing Guidelines' and 'Billing Guideline Appendix' sections in the full policy (available at ProvidenceHealthPlan.com) for exact diagnosis code lists and Column A/B specifications. Consequence: Claims submitted without proper diagnosis code pairing will be denied as not medically necessary and cannot be resubmitted.