Part B Insider (Multispecialty) Coding Alert

Published on Mon Nov 03, 2003 PDF

For multiple billings, know the difference between flat warts and others

If you're only billing once for wart destruction, you could be costing your practice big money.
 You can bill +17003 (Destruction, all benign or premalignant lesions; second through 14th lesions, each) for each wart your physician destroys, up to the 15th wart. You bill 17000* (Destruction, all benign or premalignant lesions other than skin tags or cutaneous vascular proliferative lesions; first lesion) and then one unit of 17003 for each additional wart. If the patient has more than 14 lesions, you simply CPT bill 17004 (Destruction; 15 or more lesions).
 
But many coders fail to understand this. Coders "just try to bill 17003 once, and think, 'That covers me up through the fourteenth wart,' " says Laura Pettigrew with Methodist Medical Group in Indianapolis. They don't realize they should bill individual units of 17003 for each additional wart the physician destroys.
 
Or coders will believe that all warts are flat warts, and bill 17110* (Destruction, of flat warts, molluscum contagiosum; up to 14 lesions) by mistake, says Kathy Pride, a coding consultant with Quadramed in Port St. Lucie, Fla. Unlike 17003, you can only bill one unit of 17110 for the first 14 warts. If you look at an illustration of flat warts in a medical book, "they almost look like acne. They all run together," Pride says. But the most common kinds of warts are covered by 17003, not 17110.
 
But if the physician is excising the warts instead of destroying them, don't bill for more than five units in one day, says Beth Glenn with Jefferson Family Physicians in Jefferson City, Tenn. You bill for these using 11400-11471 (Excision - benign lesions), depending on the size of the wart and what else the physician did. In Glenn's experience, Medicare and other payers will almost never pay for excision of more than five warts per day.
 
Destruction means burning or slicing the wart off, but excision means cutting beneath the surface "to core it off," Glenn says. "I advise my doctors not to do more than five at a time because of the discomfort for the patient," plus the difficulty of sterilizing multiple areas.