Wiki Wart- Shave or Cryotherapy?

[anne32]

A patient has come in with a "persistent wart". He has received several rounds of cryo in previous visits and the wart is not going away. The provider decides to shave or excise the wart and also does cryo on the wart. I'm not sure whether he shaved or excised the lesion as his notes are not clear, but I'm thinking I would only code the cryo anyway? Is this correct? It was not sent to pathology so I can't code an excision.

This is just the procedure section of the note.


1. Wart
PROCEDURE: Cryotherapy, Skin
PROCEDURE: Excision Lesion Trunk, Arms, Legs 1.25-2.0 CM
Notes: Will watch for infection. If it does not appear to be gone after it heals they will call and we can refer to dermatologist.


Procedures
Shave Biopsy:
Indication wart. Consent All risks, benefits,and potential complications were discussed including bleeding, infection, scarring, and the need for further surgery to improve the resultant scar or to remove a cancerous process. It was explained that this procedure was for diagnostic purposes and was not being performed withthe intention of curing the condition, Informed consent obtained. Location 1, R/O wart to the right ankle. Method Area infiltrated with 1% Lidocaine with epi, dermablade used to shave lesion tangentially, silver nitrate for hemostasis and then the area was retreated with cryo.

 

[anne32]

Where's Debra Mitchell when you need her? lol

 

[thomas7331]

I would code just the cryotherapy - the biopsy is a component of the destruction procedure so wouldn't be billed separately. A shave or excision code wouldn't be appropriate because it's only documented as the method for obtaining the biopsy, not a separate removal or excision procedure. It should have been sent to pathology - the provider's said this was being done for diagnostic purposes?

 

[CatchTheWind]

The provider says that he did three different things: cryotherapy, excision, and shave biopsy. The excision and shave biopsy are not billable because they bundle with the cryotherapy, per the CCI edits. So although I disagree with Thomas's reasoning (if an excision was done, it doesn't matter whether the purpose was for getting a biopsy or for removing the lesion, it's a legitimate excision regardless of intent), I come to the same conclusion: bill for the cryotherapy only.