I was discussing with my biller verruca follow-ups. Most of these are #15 blade debridements in the process of reducing the hyperkeratosis and verrucous tissue to allow topical medication to work. With most of these, as I am managing the attempted eradication of the wart, I bill a 99212 (I am a conservative biller). However, you hear colleagues (most of the time it’s not good) talking about using 17110 (Destruction of benign lesion. In its description it states surgical curettement and by destruction I would assume this means removal. So I don’t think 17110 is the appropriate code to bill. What are your thoughts?
The other one is 11300, which is shaving benign lesions: Is this appropriate for verruca? I am thinking this is more shaves for biopsies.
So, in the end, am I stuck using 99212 for verruca follow-ups such as I have described? Or is there another option?
As far as the most appropriate CPT code to use for the treatment of verrucae, when you see the patient to follow up the treatment of the prior encounter, of course the debridement of the hyperkeratotic tissue is necessary in order to see the status of the lesion. Assuming that the verruca is still present and it is painful (It is imperative to have a secondary diagnosis such as pain otherwise the health insurance carrier might interpret the treatment of the lesion as cosmetic and it would be non-covered), if you are going to apply a topical agent such as Cantharone to the lesion, this would be classified as chemosurgery and it would be appropriate to bill CPT code 17110. CPT code 17110 is defined as the following: Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions. It would not be appended by an anatomical modifier as it is based on the number of lesions treated, not where it is located anatomically. This CPT code has a 10 day global period. If you are removing the hyperkeratotic, overlying tissue and are having the patient apply a topical medication at home and you are only evaluating the status of the lesion, 99212 would be the most appropriate CPT code to bill. I would not use the 11300 series of CPT codes. This is for the shaving of epidermal or dermal lesions. This is not what is being performed. You are essentially trimming hyperkeratotic overlying tissue. This would be classified as RFC.
This is my opinion.
Michael G. Warshaw
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