Podiatry Coding & Billing Alert

Question: A patient came for a follow up visit after treatment for an injured ankle. During the examination, our podiatrist found a lesion on the sole of the patient's  oot. The doctor decided to shave the lesion. I billed 11301 for the procedure with 99213, but Medicare denied the claims. What could I have done wrong?

California Subscriber

Answer: You used the wrong code. Code 11301 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm) does not cover the feet.

To bill correctly, you have to use a code from the 11305-11308 series. Depending on the size of the lesion, you'll report one of the following codes:

• 11305 -- Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5cm or less;

• 11306 -- ... lesion diameter 0.6 to 1.0cm;

• 11307 -- ... lesion diameter 1.1 to 2.0cm; or

• 11308 -- ...lesion diameter over 2.0cm.

Don't forget: In addition, you need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) because the lesion shaving was a separate procedure from the visit. You should also add modifier LT (Left side) or RT (Right side) along with HCPCS Level II modifiers T1-TA (left foot , second digit -- Left foot, great toe) to indicate which foot and digit were involved.

Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. The wound does not require suture closure.

Pitfall: If your podiatrist uses chemical or electrical cauterization of the wound, don't be tempted to bill for these services. CPT includes those procedures in the shaving codes. Additionally, Medicare does not separately reimburse for surgical trays (A4550, Surgical trays) but some third-party payers may pay you for them. To be sure, check with the payer first to determine whether you should report surgical trays separately.