“I have a patient who returns to the office for regular treatment of a hyperkeratotic lesion. Our documentation states “a hyperkeratotic lesion with a punctate keratin core with obliteration of skin tension lines to the sub 5th metatarsal head.” The plan is documented as “Cold spray to the lesion for anesthesia. The lesion was then circumscribed with #15 blade. The keratotic core then excised down to the level of the basement membrane. Bleeding was appreciated, then controlled with compression. No biopsy was performed.” Can I ever bill this as a CPT 11305? with a D23.7? If so, can this be done every 10 weeks?”
I understand that the patient in question has a “hyperkeratotic lesion with a punctate keratin core with obliteration of skin tension lines to the sub 5th metatarsal head.” This would be quite painful over time, and it obviously needs to be treated regularly to relieve the symptomatology. Approximately every 10 weeks, the lesion is circumscribed with a #15 blade and then the central core is “excised” to the basement membrane. How should this be coded?
CPT 11305 is defined as the following: Shaving of epidermal or dermal lesion, single lesion, feet; lesion diameter 0.5 cm or less. Clearly what was performed in the above post was not a shaving of the lesion. In fact, prior to 2019 when CPT 11102 defined as: Tangential biopsy of skin (eg. shave, scoop, saucerize, curette); single lesion came into existence, CPT 1130X was the series of CPT codes that were essentially used for shave biopsies. Clearly, this was not the procedure that was performed.
The procedure that was performed included the excision of the “keratotic core to the level of the basement membrane,” however, the procedure cannot be classified as an excision. An excision needs to be performed below the level of the dermis into the subcutaneous tissue. The procedure in question was performed to the basement membrane. The basement membrane separates the epidermis from the dermis. Clearly, this cannot be coded as an excision. Therefore, the CPT 1104X series of codes cannot be used.
The procedure that was performed within the above post is performed every 10 weeks. It is not classified as shaving, nor is it classified as an excision. When all of the variables are factored in, the only viable option is routine foot care. If the patient meets the criteria for “At Risk,” routine foot care, it would be a covered service. Otherwise, the patient would need to pay out of pocket.
This is my opinion.
Michael G. Warshaw
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