Podiatry Coding & Billing Alert

Here’s what to do when your podiatrist wants to biopsy as well as destroy a wart. 

If your podiatrist regularly removes warts, you may be putting yourself at risk by assigning incorrect — but better paying — codes. Here are some common mistakes you need to avoid to get the most out of your wart removal claims — and steer clear of fraud allegations.

Pitfall 1: Assigning More Than 1 Unit of Service

Your physician will most likely use destruction as the method for wart removal, and you will use the 17000 series of CPT® Codes. The physician 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. 

If the number of warts removed is 14 or less, bill procedure code 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions), and one unit of service. 

If your physician removes 15 or more warts, bill procedure code 17111 (…15 or more lesions) with one unit of service.

Lesson Learned: You should not bill both codes on the same claim or submit either code with more than one unit of service. 

Pitfall 2: Overlooking Biopsy Services

One other error prone area is coding for excision and biopsy. Sometimes, the physician may decide to excise and biopsy a lesion if he suspects that the wart-like growth may not be a wart or is malignant. 

You should not report excision codes if the physician has documented biopsy. The reason is that excision entails complete removal of the lesion whereas biopsy usually means that the physician has partly removed the growth. 

Lesson Learned: Submit 11100(Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for the first biopsy. For each separate biopsy after the first one, use add-on code 11101(…unless otherwise listed; each separate/additional lesion [List separately in addition to code for primary procedure]). For example, if three lesions are biopsied, you would submit codes 11100, 11101, and 11101 again. 

Pitfall 3: Forgo Using Lesion Destruction Codes

You may have come across opinions suggesting that in some cases, you may reap greater benefits for multiple lesion destruction if you use three other codes:

• 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses]; first lesion), 
  
• 17003 (... second through 14 lesions, each [list separately in addition to code for first lesion]) and 
  
• 17004 (... 15 or more lesions) for common and plantar wart removal. 
  

But actually these codes are only and strictly applicable to premalignant lesions, and warts do not fall into this category. 

Example: Your podiatrist used a laser to remove five lesions of verruca vulgaris on a patient. You should stick with 17110 since the diagnosis is common warts (verruca vulgaris) or 078.10 (Viral warts, unspecified).You may be tempted to use code 17000, but that does not apply when the procedure is simply destroying warts.

Lesson Learned: Codes 17110 and 17111 are for the destruction of benign lesions only, which includes laser surgery, electrosurgery, cryosurgery, chemosurgery, and surgical curettement. 

Guidelines for assigning code units for premalignant lesions (17000-17004) differ from those for benign warts, so be sure to read the code descriptors carefully. Do not forget that you must code based on your physician’s documentation.