Podiatry Coding & Billing Alert

CPT 11055, 11420, or 17000? Your coding will depend on the method used.

There may be no specific ICD-9 code for porokeratotic lesions, and there may not be a standard treatment for it -- and podiatrists may not even be able to agree on what they're called -- but that doesn't mean that there are no coding solutions for these services.

This condition is a special type of callus with a deeply imbedded nucleated core that a podiatrist 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 podiatrists call 'seed corns,' and other podiatrists 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 exists for porokeratotic lesions, but you can safely report 701.1 (Keratoderma, acquired) for the condition.

Choose the Best Treatment Code

Now, more and more podiatrists 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). Some podiatrists administer treatment to the underlying bone or try to surgically remove the lesion (11420-11426, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia ...). Others are trying sclerotic injection therapies, or even injecting synthetic gel material underneath the lesion to put a pad between the skin and the bone in hopes that the lesion will go away once they remove the pressure.

In most cases, though, you'll probably be coding an excision or debridement -- but watch out for what your payer will accept.

Example: A podiatrist 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 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses] ; first lesion), experts say, 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.

Take Another Look at Coverage Determinations

Medicare and other insurances do not cover most "callus" removals because this is considered routine foot care. But if the podiatrist has indicated any pain accompanying the condition, you might want to reread your coverage determinations. Why: Some carriers may not consider a porokeratotic lesion treatment routine foot care if there is documentation of pain.