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Family Practice Coding Alert

Six Factors Affect Reimbursement for Wart Removal

No fewer than six distinct factors impact coding for wart removal, and each element has a significant bearing on payment. Warts are usually benign growths and, because removal is often viewed as a routine procedure, family practices sometimes assign the same sets of codes without considering ways to maximize their reimbursement. The following questions may assist coders as they review documentation and determine which codes are most advantageous to assign.

1. What is the method of removal? Warts are almost always removed by destruction, described in the 17000 series of CPT Codes . Methods of treatment include cryosurgery, laser, chemical treatment and electrosurgery. On occasion, if the physician suspects that a wart-like growth may be something other than a wart, the lesion may be excised and biopsied. Excision codes are found in the 11000 section of CPT and are assigned according to the method used, the site of the excision and, in some cases, the number of warts removed.

Family practice coders should note that if warts and other lesions are removed from different sites, destruction and excision codes can be billed on the same date of service. For example, if a physician excises a growth on a patient's arm, but destroys a series of warts on the patient's foot, codes from both the 17000 series and the 11000 series can be reported.

2. What type of wart has been removed? The physician must document the specific type of wart being removed because that determination could have a substantial impact on reimbursement. "There is often some misinterpretation about what is a common wart, a plantar wart and a flat wart," explains Laura Pettigrew, RHIA, CCS-P, CPC, training and auditing coordinator for Methodist Medical Group, which provides coding services to 96 physicians around Indianapolis. Nonetheless, she says, this is an important distinction to make.

Because 17110* (destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions) and 17111 (... 15 or more lesions) specifically mention flat warts in their descriptions, many practices automatically assign them for all wart removal. However, three other codes, 17000* (destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion), 17003 (... second through 14 lesions, each [list separately in addition to code for first lesion]) and 17004 (... 15 or more lesions), may be assigned for common and plantar wart removal -- and may result in greater reimbursement when multiple lesions are destroyed. In fact, the parenthetical comment following the definition for 17111 directs [...]