Podiatry Coding & Billing Alert

Hint: Never report codes 17110 and 17111 on the same claim.

If your podiatrist performs wart removal, you must always check the documentation and identify whether he used destruction or biopsy because your code choice will depend on this detail. When your podiatrist performs a biopsy, you must dig even further into the documentation and see which type of biopsy they used.

Take a look at all you need to know to keep your wart removal claims on the up and up.

Focus on 17110 and 17111 for Destruction

If your podiatrist uses destruction for common, plantar, or flat wart removal, look to the following codes:

• 17110 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions). Note: If your podiatrist removed 14 warts or less, report 17110 and one unit of service.
• 17111 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions). Note: If your podiatrist removes 15 or more warts, report 17111 with one unit of service. Never submit either 17110 or 17111 with more than one unit of service.

An example of when to use code 17111 is when treating mosaic warts, says Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. “Mosaic warts are benign and grow in clusters. They can often number over 50 in a group. Although there are many more than 15, you would still report 17111.”

Destruction explained: Types of destruction include the following:

Laser surgery: This procedure, “uses special light beams instead of surgical instruments for surgical procedures to heat the wart to destroy tissue,” says M. Dolores Farrer, DPM, MBA, wound care consultant and owner of Owner of Lagniappe Wound Care Consultants, LLC in Columbia, South Carolina. “This treatment may cause scarring. Some studies have shown that this treatment is the least effective in plantar warts.”

Electrosurgery: Electrosurgery is a method of cauterization (heat energy) using electricity to burn tissue and then seal off the blood vessels, Farrer says. The podiatrist applies a metal probe with a current to burn the wart off. This is one of the oldest treatments for warts, but it has been shown to be more effective than cryosurgery. The patient may need multiple sessions to completely remove the wart, but less than other treatments such as laser therapy.

Cryosurgery: Cryosurgery is also known as “cryotherapy,” according to Farrer. The podiatrist applies liquid nitrogen to “freeze” the wart tissue; the extreme cold destroys cells in the top layer of the skin and may result in a blister. “This procedure may need to be repeated several times over a few weeks. Cryosurgery for warts is not recommended for patients with diabetic foot problems or peripheral arterial disease since it could lead to nerve damage or chronic wound healing,” Farrer says.

Chemosurgery: With chemosurgical excision, the podiatrist will repeatedly apply a harsh chemical like salicylic acid, trichloroacetic acid, or monochloroacetic acid to the wart daily for up to 12 weeks. This procedure “is more time-consuming than surgical removal but is effective and does not cause scarring,” Farrer says. “However, due to the slow destruction of the wart and multiple visits, it may take as long as six weeks to see results.”

Surgical curettement: This procedure is also known as “curettage” and involves cutting or scraping off the wart tissue using a curette, per Farrer. The wart is often treated first with salicylic acid. This is “one of the more popular ways to treat warts but is time-consuming and has higher remission rates than other more aggressive treatments.”

Pinpoint Correct Codes for Biopsies

On the other hand, if your podiatrist biopsies a lesion because he suspects that the wart-like growth may not be a wart or is malignant, you should look to the following codes:

• 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion) and +11103 (… each separate/additional lesion (List separately in addition to code for primary procedure))
• 11104 (Punch biopsy of skin (including simple closure, when performed); single lesion) and +11105 (… each separate/additional lesion (List separately in addition to code for primary procedure))
• 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion) and +11107 (… each separate/additional lesion (List separately in addition to code for primary procedure)).

As you can see, your podiatrist can choose from three different biopsy methods: tangential, punch, or incisional; so, you will need to read the documentation carefully to identify the appropriate method and choose the appropriate code.

Tangential biopsy defined: Tangential biopsies include shave, scoop, saucerization, or curette techniques performed using a sharp blade to remove a sample of the epidermal tissue and may include some of the dermal tissue, Farrer says.

Punch biopsy defined: Punch biopsies involve taking a deep sample of skin with a biopsy instrument, Farrer explains. This short, cylinder instrument removes a center core of tissue. Once local anesthesia is complete, the cylinder is pushed into the tissue and rotated until it cuts through all layers of the skin, including the dermis, epidermis, and superficial parts of the subcutaneous (fat) tissue.