Pediatric Coding Alert

Question: Our pediatrician documented “Skin lesion appearance consistent with verruca, no signs of infection. Sharp debridement of full thickness down to healthy base without any issues.” He likes to use 11055 for this, but since he used a scalpel and didn’t use any of the destruction methods, would 11042 or 97597 be better? Or is 17110 appropriate in this situation?

AAPC Forum Participant

Answer: Code 97597 (Debridement (eg, high pressure waterjet with/ without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less) is not appropriate in this situation as it describes “selective debridement or active wound management,” which “involves the removal of specific areas of devitalized tissue with the use of a sharp instrument” according to AHA HCPCS Coding Clinic volume 18, number 11 (2018). While your pediatrician did use a sharp instrument for the debridement in the encounter, the procedure you describe is not open wound management, eliminating this code choice.

Another code you mention — 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) — also does not document the encounter you describe accurately. This is because the code reports “surgical debridement for injuries, infections, wounds, and chronic ulcers” per the AHA HCPCS Coding Clinic. Additionally, your do not indicate that there is documentation of the debridement at the subcutaneous depth.

Your provider’s suggestion, 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion), would also not be correct as the kind of lesion mentioned in the code descriptor is not a plantar wart or verruca, which is what your provider removed. Instead, following the guideline that accompanies 11055, you would use 17110 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) or 17111 (… 15 or more lesions) to report “destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions” per the code descriptor.

Why? Even though the code mentions various methods of destruction, these are only examples, and the codes in the subsection come with the instruction that “destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement.”