Oncology & Hematology Coding Alert

You select from 11055, 11420, or 17110 depending upon the method used.

Your oncologist reported a keratosis, and the histopathology says it isn’t malignant. While the result is good for the patient, you may find reporting hyperkeratotic skin lesion services isn’t a bed of roses. Here’s how to assign the right services and diagnosis codes for your porokeratotic lesion encounters.

Clinical refresher: This condition is a special type of callus with a deeply imbedded nucleated core that your clinician cannot easily dig out. It can also be quite painful for the patient.

Watch for: You may come across a variety of different terms to name the same condition. “Some may confuse them with warts or with what physicians call ‘seed corns,’ and other physicians will refer to them as ‘IPKs’ (intractable plantar keratosis), but they’re not really the same thing,” says Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.

Best bet: No specific ICD-9-CM exists for porokeratotic lesions, but you can safely report 701.1 (Keratoderma, acquired) for the condition.

Choose the Best Treatment Code

Physicians are looking into treatment options other than simply removing the callus (11055, Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion). In most cases, though, you’ll probably be coding an excision or debridement.

Example: A physician debrides the area and applies acid in hopes of destroying the lesion. The most proper code to use for destroying a skin lesion with acid is 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions), says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. But applying an acid is not necessarily a treatment per se. The question your payer is likely to ask is “Is it medically necessary and reasonable and within the standard of care?”

If your carrier considers the lesion removal routine care and a covered service, remember that some carriers may prefer to use the code series 11055-11057, Beresh adds. “Code according to the procedure performed and documented. If coverage of the service is in question, obtain an advanced beneficiary notice (ABN) or waiver of liability for non-Medicare patients as appropriate,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc.