Thursday, 1 December 2011

Common Wart Removal Codes Doubles Your Reimbursement

Internists deal with forthright integumentary complaints that were once voluntarily referred to dermatologists and this includes wart removal. However all too often internists carry out wart removal procedures excluding distinguishing between wart categories and without knowing that those differences can impact their rightful reimbursement. Also, coders who aren’t vigilant to the intricacies of coding terminology may be extending or perpetuating the misapprehension.

Codes For Wart Removal

The problem lies in a misunderstanding of the applicable CPT codes ,. When internists and coders go for a wart removal code, a lot of them only see 17110 [destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions] or 17111 [ 15 or more lesions].

Though, using 17110 and 17111 often result in underbilling as reimbursement is not different (1.69 relative value units [RVUs] for 17110) for removing one wart as it is meant for 14 warts, though the single-claim RVU for 17111 is 2.11 for 15 or additional warts, irrespective of whether its 15 or 50 warts.

Read Code Descriptors Cautiously

Remember that the destruction of common warts must be coded CPT 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) and 17003 ( second through 14 lesions, each [List separately in addition to code for first lesion]).

The word wart does not exist in the descriptor for these particular codes and that’s the chief reason why so many internists and coders are unsuccessful in using them properly. You have to go through the guidelines under Destruction (page 56 in CPT 2001), just prior to the description for the 17000 series of codes to realize that they are applicable not only to several lesions but also to warts.

The words in parentheses subsequent to the explanation for 17111 state, For destruction of common or plantar warts, look for 17000, 17003, 17004. So, until you do a little investigation, its not clear that the accurate way to bill for the destruction of these common warts is to use 17000 and 17003.

Note: Never use 17003 individually. It should be used with CPT 17000. Moreover, you should not report 17004 (15 or more lesions) along with 17000-17003. Code 17004 is always reported individually.

Reimbursement Can Increase

Putting the CPT 17000 series codes to work makes a big difference in reimbursement. For instance, in case a patient comes with eight common warts on the back of one hand, then the internist can code CPT 17000 (1 unit, 1.67 RVUs) for the first wart, and 17003 (7 units, 0.39 RVUs each) for the outstanding warts.

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