Podiatry Coding & Billing Alert

Myth 1: Code Corn Removal Like All Other Benign Lesion Removal

Reality: There are different types of benign lesions such as corns and warts, and they need to be coded differently from one another depending on various factors such as the type of lesion, the method of destruction, and the number of lesions destroyed.

Example: The podiatrist used a blade and local anesthesia to cut one corn off a patient’s left foot.

You should report 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion) for this procedure because, according to the medical documentation, your podiatrist removed just one, single lesion. This corresponds with the descriptor for 11055, which tells you the code for a single lesion removal.

On the other hand, if your podiatrist removes more than one corn or callus, you should turn to the following codes:

• 11056 (… 2 to 4 lesions)
• 11057 (…. more than 4 lesions)

To code for the removal of other benign lesions, such as plantar warts, you should turn to two different 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) or 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 depending on the number of lesions removed.

“Integumentary lesion destruction is all about the numbers. It’s important to know how many were removed, what type of lesion, and how the lesions were destroyed,” said Sydni Young, CPC-A, medical coder II for Healthcare Resource Solutions in Evansville, Indiana.

Myth 2: Premalignant and Malignant Lesion Removal Are Coded the Same

Reality: The treatment and coding of premalignant and malignant lesions often differs significantly. While both types are abnormal and necessitate treatment, how they are managed can vary.

Premalignant lesions are abnormal growths or patches of cells that have the potential to become cancerous but have not yet done so. They are often treated with a goal of preventing the development of cancer. Methods can include topical medications, excision (surgical removal), cryotherapy (freezing), or laser therapy, among others. To code the removal of premalignant lesions, you would look to 17000-17004 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses) …) with the difference in codes based on number of lesions.

“It is worth noting that many errors can be made by misunderstanding why CPT^® uses the symbol ‘eg’ in many code descriptions. Often it will give you examples, which is what ‘eg’ means. This is not an all-inclusive list. When the code 17000 says ‘eg. actinic keratosis,’ it does not mean that this is what the patient has, but it is an example of a common reason for the destruction,” says Jennifer McNamara, CPC, CCS, CPMA, CRC, CDEO, COSC, CGSC, COPC AAPC Approved Instructor, CEO and physician education at Healthcare Inspired, LLC, in Bella Vista, Arkansas. The same is true with the destruction technique. “When you see the ‘eg’ and the technique of laser surgery, electrosurgery, cryosurgery, the purpose is to show the lesion is destroyed and can be by any technique that is a destruction,” says McNamara.

Malignant lesions are cancerous growths that have the potential to spread to other parts of the body. Treatment often involves more aggressive methods, such as surgery to remove the lesion, radiation therapy, chemotherapy, immunotherapy, targeted drug therapy, or a combination of these. The choice of treatment depends on factors like the type and stage of the lesion, its location, the overall health of the patient, and the potential side effects of the treatment. It’s crucial that any suspicious lesions are evaluated and treated by a healthcare professional to ensure the most appropriate care. Use codes from 11620-11626 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia…) with the difference in codes this time based not on the number, but the size, of the lesions removed.

Myth 3: Code Only the Size of a Removed Malignant Lesion

Reality: The code should always account for both the size of the lesion and the necessary additional margins taken during its excision.

Example: A provider removes an 0.8 cm melanoma from a patient’s left foot by creating an elliptical incision down to the fascia with margins of 0.2 cm. The provider closes the surgical site with six sutures.

In this case, you might be tempted to report the procedure using 11621 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm) based on the 0.8 cm lesion size. However, that would be incorrect, as the lesion removal code should take into account the lesion size plus two times the smallest surgical margin. In our example, the lesion is 0.8 cm, but the margins add on an additional 0.4 cm (2 x 0.2 cm). This gives a total excised diameter of 1.2 cm, which means you would use 11622 (… excised diameter 1.1 to 2.0 cm).