Podiatry Coding & Billing Alert

Question: Our podiatrist has treated a patient for a plantar wart with debridement and freezing monthly for the last six months. The patient recently requested removal of the wart. The podiatrist documented that she used a scalpel to remove a full thickness 0.5 cm elliptical excision on the foot and removed the lesion with hyperkeratosis. The podiatrist suggests 11305, but I don't think that's right. How should I code this?

North Carolina Subscriber

Answer: The best code for the procedure you describe would be one from the Integumentary code range (11420-11426) depending on the lesion's size. Code 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) seems like a good bet.

Code 11305 (Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less) is not correct because the podiatrist documents a full-thickness removal. Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes a simple (non-layered) closure.

Tip: To differentiate between shaving (11300-11313) and excision (11400-11646), look at the removal's depth. Technically, any time the physician removes skin tissue, they are performing an "excision." For coding purposes, however, CPT narrowly defines an excision as involving "full-thickness (through the dermis) removal of a lesion." Shaving, in contrast, involves "sharp removal ... without a fullthickness dermal excision."