Pediatric Coding Alert

Plantar wart removal now falls under 17110

If your encounter sheet contains only 17000 and 17003, now's the time to add -- and maybe even replace them with -- 17110 and 17111.

In the past, you coded wart removal with 17000-17003, but revisions to these codes for 2007 mean you'll primarily use 17110-17111. Make sure you educate staff on the following changes to these codes:

• 17000 -- Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions [e.g., actinic keratoses]); first lesion

• +17003 -- ... second through 14th lesions, each (list separately in addition to code for first lesion).

Difference: These codes previously also included "all benign or premalignant lesions (e.g., actinic keratoses)."

• 17110 -- Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions

• 17111 -- ... 15 or more lesions.

Revision: Codes 17110-17111 previously referred to destruction of "flat warts, molluscum contagiosum, or milia."

Change 1: Determine 17000-17003 vs. 17110-17111 Based on Type

As of Jan. 1, 2007, you should be assigning lesion destruction codes based on whether the lesion is premalignant or benign.

CPT 2007 revised the descriptors for 17000-17003 to make them apply only to premalignant lesions, says Pamela J. Biffle, CPC, CCS-P, ACS-DE, director of operations for the Coding Resource Network (CRN) Institute headquartered in Salt Lake City. "For destruction of benign lesions other than skin tags or cutaneous vascular proliferate lesions, you have to go to 17110-17111." 

Change 2: Start Using 17110-17111 for Plantar Wart Removal

The revisions mean that common and plantar warts are now classified as 17110-17111. "A cross-reference has been added following code 17003 to indicate that because plantar warts are not considered to be of a premalignant nature, the destruction of these lesions is reported with 17110-17111," according to CPT Changes 2007 -- An Insider's View.

Old way: Before the CPT 2007 changes, you should have coded common and plantar warts with 17000-17003, Biffle says. "Everything except flat warts, molluscum contagiosum and milia were classified to 17000-17003."

Because there is a significant difference in the amount of risk between premalignant and benign lesions, the AMA redefined -- and CMS revalued -- the codes based on this division. The 2007 National Physician Fee Schedule values the premalignant codes at 2.07 (17000) and 0.18 (17003) transitional nonfacility total relative value units, compared to the benign codes RVUs of 2.48 (17110) and 3.28 (17111).

At first glance, you may incorrectly think that this revision has increased the value for benign lesions higher than for premalignant lesion destruction. But if you look at the structure within each code, the value of treatment for a premalignant lesion is higher.

Change 3: Choose Series Based on Dx

You now only have to look as far as the ICD-9 code to determine if you should use the 17000-17003 series or the 17110-17111 codes. Codes 17000-17003 "may only be reported with diagnosis code 702.0 (actinic keratosis)," states the American Academy of Dermatology (AAD) in "Frequently Asked Questions on CPT Destruction Code Changes for 2007."

Use 17110-17111 to report destruction of all other benign lesions that are medically necessary and would be reported with any other appropriate ICD-9 codes, the AAD instructs coders. Physicians will most commonly link 17110-17111 to 702.11 (inflamed seborrheic keratosis) and 078.10 (Viral warts, unspecified), which includes common warts (verruca vulgaris). But you could also report 17110-17111 with 216.x (Benign neoplasm of skin) and 238.2 (Neoplasm of uncertain behavior of other and unspecified sites and tissues; skin).

Change 4: Include Wart Removals in 17110

The shift from mainly using 17000-17003 to 17110-17111 "may hurt pediatricians a little," Biffle says. "You won't be able to code for each common or plantar wart removal."

Reason: With 17000-17003, you could code each destruction, Biffle says. But the new code you have to use encompasses 14 lesions.

When reporting destruction of benign lesions, you should report 17110 for up to 14 lesions or 17111 for 15 or more lesions. "On a given patient on a given day, you should choose either 17110 or 17111, never both," said Daniel Mark Siegal, MD, MS, during a Nov. 16, 2006, presentation at the AMA CPT and RBRVS 2007 Annual Symposium in Chicago.

Example 1: You destroy five plantar warts (078.19, Other specified viral warts). In this case, you should now report 17110.

Example 2: You use NO2 to destroy 50 molluscum contagiosum (078.0). Code this scenario with 17111. Keys: Do not report 17110 in addition to 17111, and never code multiple units of 17111.

Tip: Offset your payment loss by looking for opportunities to use anatomically specific wart removal codes instead of the integumentary codes, Biffle says. For instance, correctly coding destruction of perianal warts with 46900 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical) instead of 17110 will net you an additional $96.36. (In the 2007 National Physician Fee Schedule, 46900 contains 4.92 transitional nonfacility total RVUs or pays $186.46 [4.92 x 2007 conversion factor 37.8975] compared to 2.38 RVUs for 17110, which pays $90.20 [2.38 x 37.8975]).

Other site-specific lesion destruction codes you may occasionally use include:

• boy or male genitalia: 54050 (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical)

• girl or woman sites: 56501 (Destruction of lesion[s], vulva; simple [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]).