“I have a patient who returns to the office for recurrent six intractable porokeratosis. I have treated this situation for the patient about three months previously and I billed CPT code 17110 after treating it with an application of Cantharone. Can I bill CPT 17110 at this second visit?”
Let’s take a careful look at this scenario. What exactly is an intractable plantar porokeratosis? A porokeratosis can be by definition a variety of different skin lesions ranging from a benign lesion with a punctate center often referred to as a “plugged sweat gland” to a precancerous lesion. Based upon the above post, the six lesions in question are benign punctate lesions on the plantar aspect of the foot.
When the patient initially was treated for these 6 lesions, Cantharone was applied to the lesions. The CPT code that was billed was CPT 17110 which 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. I would agree that this is the appropriate CPT code to bill since the application of Cantharone to the lesions is classified as chemosurgery since Cantharone is an acid.
It appears that based upon the above post, Cantharone was applied to the lesions and the patient was not seen for 3 months when it is apparent that the lesions were still present, or perhaps resurfaced when the patient returned. Since CPT 17110 is classified as a minor surgical procedure code with a postoperative global period of 10 days, the reimbursement of this CPT code is not only for the actual procedure that was performed, but also for the postoperative global period. Approximately 65-80% of the reimbursement is for the procedure that was performed and the remaining 20-35% of the reimbursement is for the postoperative global period. It is important to follow up with the patient within the postoperative global period not just because you were reimbursed to do so, but also to evaluate the status of the lesions. After all, the operative word in the definition of CPT 17110 is “destruction.” How to you know if the lesions were “destroyed” unless the “surgical site” is evaluated? You don’t. If the patient was seen postoperatively and the lesions were not “destroyed,” it would be appropriate to reapply the Cantharone. How many times can Cantharone be applied if the lesions are still present? There are different opinions regarding this point of information. Medicare for example has a number that they refer to when repeat treatments are performed. That number is four. If you don’t see a significant change or destruction of the lesions after four treatments, it is time to perform another type of treatment (ie. surgical curettement or excision) or the patient needs to be referred elsewhere. This is my position.
Now, if the application(s) of Cantharone actually destroyed the porokeratosis that were present and this was documented within the medical record and six months later the lesions returned, based upon the information above, it would certainly be appropriate to once again bill CPT 17110 as long as it achieved the desired result and it was utilized and documented correctly.
This is my opinion.
Michael G. Warshaw
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