Podiatry Coding & Billing Alert
Radical Resection, Shaved, Debrided or Excised? Depth Holds the Key
Understand the difference between lesion and tumor before you code.
Was that a foot tumor which your podiatrist treated? Are you sure that it wasn’t a lesion? If the documentation is not so clear or you aren’t able to interpret the procedure or the diagnosis, your provider could be saying goodbye to perfectly legitimate claims and reimbursement since you haven’t been able to capture the work done.
You need to grasp just when you should be using a lesion debridement, lesion shaving, or lesion excision code instead of a code for foot tumor procedure. The confusion apparently stems from a lack of understanding of the differences between the two conditions, and the corresponding codes for shaving, excision, and resection methods. Here are a few pointers to help you pin the codes down and avoid future denials.
Depth of Removal is Key
Podiatrists treat lesions in one of several ways: debridement, shaving, or excision. To distinguish among the procedures, you must consider how deep the podiatrist must go to remove the lesion from the foot.
Check this out: Debridement is the surgical removal of diseased or contaminated tissue or skin. Shaving is the removal of dead skin using a slicing or sawing motion. You can use the following debridement codes for lesions:
For shaving you have to use a code from the 11305-11308 series. Depending on the size of the lesion, you’ll report one of the following codes:
What’s different: In contrast, excision is the surgical removal of an organ or tissue (lesion or tumor) through an incision as deep as or deeper than the full thickness of the skin. Unlike shaving, excisions require suturing to allow the surgical wound to heal.
Podiatrists remove tumors through either excision or radical resection (excision of all or part of an organ or tissue, along with the blood supply and lymph system supplying the organ or tissue). Radical resection generally applies to malignant tumors. One clue in your podiatrist’s documentation that would indicate a radical resection is the large area covered by the procedure.
The distinguishing point for shaving/debridement/excision versus radical resection is whether the podiatrist has to go above or below fascia (a sheet or band of fibrous connective tissue). Subcutaneous tissues are usually above deep fascia. When the podiatrist removes tissues below fascia, then he is getting into radical resections.
Size Does Matter
To determine the correct code for either a lesion or tumor procedure, it is important that your podiatrist’s operative report indicates the size, depth, and location of each growth. Accurately determining lesion or tumor size will also ensure that your podiatrist gets properly compensated for the depth and difficulty of the service he provided.
Lesions vary in sizes but for the feet, CPT® provides codes for specific sizes of epidermal or dermal lesions as follows:
Take note: Lesion size determines the proper CPT® code to use and, therefore, the proper payment. You also have to remember that in determining the lesion size, your podiatrist must add the size of the surrounding margins that were removed.
Don’t forget: In addition, you need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) because the lesion shaving was a separate procedure from the visit. You should also add modifier LT (Left side) or RT (Right side) along with HCPCS Level II modifiers to indicate which foot and digit were involved.
Pitfall: If your podiatrist uses chemical or electrical cauterization of the wound, don’t be tempted to bill for these services. CPT includes those procedures in the shaving codes. Additionally, Medicare does not separately reimburse for surgical trays (A4550, Surgical trays), but some third-party payers may pay you for them. Ascertain by checking with the payer first to determine whether you should report surgical trays separately.
CPT® Offers a Separate Code Series for Tumors
If your podiatrist specifies tumor removal, you must check the patient’s records for indications that the mass is musculoskeletal in origin, such as a reference to ‘soft tissue.’ Tumor removal codes fall under the 20000 code series. You must also check for indications of the size of the excised tumor since CPT® provides codes for specific sizes, as follows:
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