Primary Care Coding Alert

Question: Our provider removed a plantar wart and documented the following: “Skin lesion appearance consistent with verruca. Sharp debridement of full thickness down to healthy base without any issues.” Under these circumstances, would it be correct to use 11042? Or is there another code that would be more appropriate in this situation?

AAPC Forum Participant

Answer: Since the documentation contains no reference of the provider debriding subcutaneous tissue, you would not be able to use 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less).

Under these circumstances, the better choice would be to use 97597 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less). This code does not stipulate the depth of the debridement, but it does stipulate other elements of the service, including topical applications, wound assessment, instructions for ongoing care, and the size of the total surface area of the debridement that must also be documented before the code can be used.

Time to query: You may want to clarify whether the provider truly debrided the plantar wart versus excised it. Removal or excision of a plantar wart would be coded to 11420-11426 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;…), with the specific code dependent on the excised diameter.