Is it appropriate to remove the core of a porokeratosis or a nucleated callus every month or two and bill it to the insurance company with CPT code 11305?
11305 Series of Codes: Shaving of Epidermal or Dermal Lesions
Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization of the wound. The wound does not require closure.
This series of CPT codes in reality are biopsy codes. A specimen needs to be submitted for pathological analysis.
The trimming or debriding of a corn, callus or hyperkeratotic tissue in any fashion does not qualify for the use of this CPT code set. The use of At Risk” Foot Care codes 11055, 11056, 11057 would be appropriate. If the patient does not qualify for “At Risk” Routine Foot Care,” this is statutorily not covered, and the patient would need to pay out of pocket. If the patient qualifies for “At Risk,” Routine Foot Care and is covered by a qualified systemic disease and Class Findings, then the “paring” of the hyperkeratotic lesion(s) would be covered no sooner than every 61 days.
Furthermore, with the introduction of the new biopsy CPT codes in 2019 (ie. 11102: Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion), are the 11305 series of codes really necessary any longer? I suspect not.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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