Pediatric Coding Alert

Plantar wart removal now falls under 17110 If your encounter sheet contains only 17000 and 17003, now's the time to add -- and maybe even replace them with -- 17110 and 17111.

In the past, you coded wart removal with 17000-17003, but revisions to these codes for 2007 mean you'll primarily use 17110-17111. Make sure you educate staff on the following changes to these codes:

• 17000 -- Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions [e.g., actinic keratoses]); first lesion

• +17003 -- ... second through 14th lesions, each (list separately in addition to code for first lesion).

Difference: These codes previously also included "all benign or premalignant lesions (e.g., actinic keratoses)." • 17110 -- Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions

• 17111 -- ... 15 or more lesions.

Revision: Codes 17110-17111 previously referred to destruction of "flat warts, molluscum contagiosum, or milia." Change 1: Determine 17000-17003 vs. 17110-17111 Based on Type As of Jan. 1, 2007, you should be assigning lesion destruction codes based on whether the lesion is premalignant or benign.

CPT 2007 revised the descriptors for 17000-17003 to make them apply only to premalignant lesions, says Pamela J. Biffle, CPC, CCS-P, ACS-DE, director of operations for the Coding Resource Network (CRN) Institute headquartered in Salt Lake City. "For destruction of benign lesions other than skin tags or cutaneous vascular proliferate lesions, you have to go to 17110-17111." 

Change 2: Start Using 17110-17111 for Plantar Wart Removal

The revisions mean that common and plantar warts are now classified as 17110-17111. "A cross-reference has been added following code 17003 to indicate that because plantar warts are not considered to be of a premalignant nature, the destruction of these lesions is reported with 17110-17111," according to CPT Changes 2007 -- An Insider's View.

Old way: Before the CPT 2007 changes, you should have coded common and plantar warts with 17000-17003, Biffle says. "Everything except flat warts, molluscum contagiosum and milia were classified to 17000-17003."

Because there is a significant difference in the amount of risk between premalignant and benign lesions, the AMA redefined -- and CMS revalued -- the codes based on this division. The 2007 National Physician Fee Schedule values the premalignant codes at 2.07 (17000) and 0.18 (17003) transitional nonfacility total relative value units, compared to the benign codes RVUs of 2.48 (17110) and 3.28 (17111).

At first glance, you may incorrectly think that this revision has increased the value for benign lesions higher than for premalignant lesion destruction. But if you look at the structure within each code, the value of treatment for a premalignant lesion is higher. Change 3: Choose Series Based on Dx You now only have to look as far as the ICD-9 [...]