Podiatry Coding & Billing Alert

Remember: Your podiatrist can use 3 biopsy techniques.

When your podiatrist performs procedures on warts, you must check the check the medical documentation to see if he used destruction or performed a biopsy. You must also know how many warts he worked on.

Read on to learn more.

Myth 1: You Can Report Destruction With Same Codes as Biopsy

Reality: You should report destruction and biopsy with two different sets of codes.

Destruction: For example, if your podiatrist uses destruction for common, plantar, or flat wart removal, you should use 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) and 17111 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions) for these services. With destruction methods, your podiatrist may expose the targeted lesion to laser beam, high frequency electrical current, or chemical agents; or, he may withdraw heat from targeted tissue, use liquid nitrogen, or surgically eradicate the lesion.

Biopsy: On the other hand, if your podiatrist biopsies a lesion because he suspects that the patient’s wart-like growth may not be a wart or is malignant, you should report a biopsy code such as from the 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion))- +11107 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)) series.

Myth 2: All Biopsies Use Same Method

Reality: If your podiatrist performs a biopsy on a wart, he can use three different methods: tangential, punch, or incisional.

• Tangential biopsy: You should report codes 11102 and +11103 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure)) for tangential biopsy. Note: During a tangential biopsy, your podiatrist will remove a sample of the patient’s epidermal tissue either with or without sections of the underlying dermis. Examples of tools your podiatrist may use to perform a tangential biopsy include a flexible biopsy blade, an obliquely oriented scalpel, or a curette.
• Punch biopsy: You should report codes 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)) for a punch biopsy. Note: During a punch biopsy, your podiatrist will use a punch tool and remove a full-thickness cylindrical sample of the patient’s skin.
• Incisional biopsy: You should report codes 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion) and +11107 for an incisional biopsy. Note: If your podiatrist performs an incisional biopsy, he will use “a sharp blade (not a punch tool) to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space,” per CPT^®.

Myth 3: You Can Bill 17110 and 17111 on Same Claim

Reality: You should not bill 17110 and 17111 on the same claim or submit either code with more than one unit of service.

If you check the National Correct Coding Initiative (NCCI) edits, you will see a procedure-to-procedure (PTP) edit between codes 17110 and 17111. Code 17110 is a Column 2 code for 17111, which means they are bundled together. Since the modifier indicator for this edit is “0,” you can never break the edit with a modifier.