# Chemical cauterization



## SR2020 (Oct 21, 2020)

Is there anyone here who may have the cpt assistant for the cpt 17250.
I would like to know what are the limitations to use this cpt.
Is is applicable to be used for any time the doctor addresses homeostasis to a scar or wound?
it has this " _Excludes Chemical cauterization when applied for hemostasis of wound"_
My supervisor thinks it should be used once silver nitrate is applied and used and is mentioned on the note_._


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## Cynthia Hughes (Oct 22, 2020)

CPT Professional edition has this instruction for 1750, (Do not report 17250 when chemical cauterization is used to achieve wound hemostasis). 17250 is a destruction code intended for destruction of proud flesh/granulation tissue.
Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.

In terms of repairing wounds, CPT states, Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed. Form this, it is clear that chemical cauterization to stop bleeding is a part of a repair not a destruction.

I hope that helps.
Cindy


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## csperoni (Oct 22, 2020)

17250 should be coded if the silver nitrate is used to remove granulation tissue, NOT to control bleeding.  Control of the bleeding is included in the procedure code for excision or repair.  So I would say it depends what you are doing with the silver nitrate, not just simply that it was used.


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## SR2020 (Oct 23, 2020)

Cynthia Hughes said:


> CPT Professional edition has this instruction for 1750, (Do not report 17250 when chemical cauterization is used to achieve wound hemostasis). 17250 is a destruction code intended for destruction of proud flesh/granulation tissue.
> Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.
> 
> In terms of repairing wounds, CPT states, Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed. Form this, it is clear that chemical cauterization to stop bleeding is a part of a repair not a destruction.
> ...


I appreciate the response which clarifies the code description.

would you consider 17250 applicable here or 57061 or an E/M?



Gyn Exam:
EXTERNAL GENITALIA: 2 cm area of granulation tissue noted at 7 o clock position
        Well healed second degree perineal laceration. 




granulation tissue was gently grasped with a hemostat and removed with gentle traction. Pressure placed for hemostasis, and silver nitrate was applied to the remaining small amount of granulation tissue. Excellent hemostasis was noted and granulation tissue was sent to pathology.


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## SR2020 (Oct 23, 2020)

csperoni said:


> 17250 should be coded if the silver nitrate is used to remove granulation tissue, NOT to control bleeding.  Control of the bleeding is included in the procedure code for excision or repair.  So I would say it depends what you are doing with the silver nitrate, not just simply that it was used.


Thanks for your response.
would you consider this 17250 or just an E/M or 57061?



Gyn Exam:
EXTERNAL GENITALIA: 2 cm area of granulation tissue noted at 7 o clock position
        Well healed second degree perineal laceration. 





granulation tissue was gently grasped with a hemostat and removed with gentle traction. Pressure placed for hemostasis, and silver nitrate was applied to the remaining small amount of granulation tissue. Excellent hemostasis was noted and granulation tissue was sent to pathology


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## csperoni (Oct 24, 2020)

To me, 57061 is the best option and what I would code.

I have seen cases where excision of vaginal granulation tissue is coded 11420-11426.  In this case, since it was removed with hemostat and not truly excised and no closure, I would not code that here.  I have also seen recommendation to use unlisted 58999 for excision of vaginal granulation tissue.  I avoid unlisted if there is another reasonable option I can justify.  On the accounts receivable end, unlisted codes are often time consuming and require a lot of additional work to get payment.

57061  The provider places the patient in the dorsal lithotomy position. The provider applies a local anesthetic to the vaginal mucosa. Once the provider identifies the location of the lesion, he destroys it by using laser surgery, electrosurgery, cryosurgery, or chemosurgery. For laser surgery, he vaporizes the lesion tissue using a high beam of light to kill the lesion or lesions. For electrosurgery, the provider uses a monopolar or bipolar instrument to destroy the lesion or lesions. In cryosurgery, the provider uses an instrument called a cryoprobe to apply liquid nitrogen to the lesion or lesions with repetitive freeze and thaw cycles performed. For *chemosurgery, the provider applies a chemical to the lesion or lesions and then removes the destroyed tissue*. The provider may also use monopolar surgery, where the current passes through the patient to complete the current cycle, or bipolar surgery, where the current only passes through the tissue between the two electrodes of the instrument.

17250 does not necessarily seem incorrect, but 57061 is more specific.

Based on the info provided, an E/M is definitely not appropriate.  If there is further documentation not provided here, it is possible an E/M is also appropriate.


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## SR2020 (Oct 24, 2020)

csperoni said:


> To me, 57061 is the best option and what I would code.
> 
> I have seen cases where excision of vaginal granulation tissue is coded 11420-11426.  In this case, since it was removed with hemostat and not truly excised and no closure, I would not code that here.  I have also seen recommendation to use unlisted 58999 for excision of vaginal granulation tissue.  I avoid unlisted if there is another reasonable option I can justify.  On the accounts receivable end, unlisted codes are often time consuming and require a lot of additional work to get payment.
> 
> ...


I like your response.
Thats all the procedure note has. From the chart i can tell that the patient had delivered. Had a 6 weeks postpartum visit and is not back. It is not the vaginal mucosa it is the external vagina. 
Its an in office procedure. I will query if any local anesthesia was applied. So thats the reason I am puzzled over the scenario.

Thank you kindly.


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## csperoni (Oct 24, 2020)

OOOOOHHH - to be honest, I wasn't even considering that & didn't notice the external location since I've only encountered removing granulation tissue from the vaginal CUFF (post hysterectomy), which is definitely more internal than you have here.  That is why I don't use 17250 (which is really a skin code).  Taking into consideration this was not vaginal mucosa, then 57061 seems a lot less appropriate. 

The vulva includes the labia majora, labia minora, mons pubis, bulb of the vestibule, vestibule of the vagina, greater and lesser vestibular glands, and vaginal orifice. The physician destroys one or more lesions of the vulva. After examination, the physician destroys lesions of the vulva by any method including laser surgery, electrosurgery, chemosurgery, or cryosurgery. Use 56501 to report single, simple lesion destruction, or 56515 to report multiple or complicated destruction of extensive vulvar lesions  

If this is external genitalia (vulva), then 56501 for destruction of *vulvar *lesions may be your best option.  

Again, 17250 does not seem wrong, but if there is a more specific code, then the more specific code should be used.


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