Dermatology Coding Alert

Check documentation for type of wart to avoid a reimbursement cold shoulder

The next time your dermatologist performs cryotherapy for warts, you'll leave the physician in the cold unless you know how to link the type of wart to the correct code, report multiple removals, and avoid global-day snags.

Common, Flat or Plantar and Why It Matters

All warts are not created the same ...quot; if the physician freezes a patient's wart, make sure you know whether the patient had a common, flat or plantar wart before selecting the surgery code.
 
Scenario: The dermatologist uses cryotherapy to remove five plantar warts from a patient's feet.
 
Best bet: For common or plantar wart removal, use 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) for the first wart, says Roxann Zellers, CPC, a coding and reimbursement specialist at the Rockford Clinic in Illinois.
 
But you should not stop there. Code 17000 describes the destruction of only one wart, leaving you with four more to report. For the remaining warts, assign +17003 (... second through 14th lesions, each [list separately in addition to code for first lesion]) four times for each additional wart the physician destroys, Zellers says.
 
If the dermatologist had removed more than 14 lesions, you would've listed 17004 (Destruction ... 15 or more lesions) once, says Carole Violette, CPC, CDC, clinical manager at Yakima Valley Dermatology in Yakima, Wash. When your dermatologist destroys up to 14 molluscum contagiosum or flat warts, you should report 17110 (Destruction of flat warts, molluscum contagiosum, or milia; up to 14 lesions), Zellers says. Report 17111 (... 15 or more lesions) if the dermatologist destroys more than 14 warts.
 
Although 17110 includes the word "warts" in the descriptor, you should not report this code for the plantar warts scenario above because the descriptor specifies "flat warts," not "plantar warts."
 
In addition, CPT states, "For destruction of common or plantar warts, see 17000, 17003, 17004."
 
Documentation quick tip: To apply the correct cryotherapy code, be sure your physician documents the type and number of warts he treated, Zellers says.

Use Modifiers for Follow-Up Treatments

Some coders append modifiers 58 (Staged or related procedure or service by the same physician during the postoperative period) or 76 (Repeat procedure by same physician) to the cryotherapy codes if they report them during a global period. Dermatologists perform follow-up wart cryotherapies during the global period when the first destruction failed.
 
Important: Cryotherapy codes like 17000 come with a 10-day global period, says Lisa Barnes, a coder with Fayetteville Diagnostic Clinic in Arkansas. Typically, this means that you can't bill for any physician services related to the original service within those 10 days, she says.
 
Coder's advantage: Get paid during the global period by attaching modifier 58 to codes for follow-up wart removals that your physician stages prior to follow-up. This way, payers will reimburse your physician for the removal during the global, as long as your documentation supports the charge.
 
Example: The dermatologist tries, and fails, to freeze a patient's wart. He notes in the operative report that the treatment for the wart will take two sessions and asks the patient to come back three days later. To report the follow-up treatment, you would use 17000-58.
 
Another option: If the dermatologist didn't stage the above procedure but attempted removal again, you may be able to append modifier 76 to the removal code. Just remember you can use modifier 58 only if the physician staged the procedure, Barnes says.