Primary Care Coding Alert

Question: When our doctor destroys warts on male patients' genitals we don't know which of the male genital destruction series codes (54050-54065) we should use. What's the difference between 54050 and 54065? Arkansas Subscriber Answer: The main difference between 54050* (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical) and 54065 (... extensive [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]) is that the first code indicates "simple" and the second "extensive."

Extensive usually means the procedure took more time or was more difficult than usual due to the size or number of lesions. For example, if the family physician removes 15 lesions, the procedure could be considered extensive and coded with 54065.

The codes also describe different methods. Code 54050 is a chemical treatment of a lesion(s), usually performed with 75 percent trichloroacetic acid (TCA). Code 54065 should be used for extensive lesions that require treatment that is more surgical. However, because lesions that need surgical treatment do not often appear on the penis, this code is most often used when there are many lesions as opposed to a significant size or condition. Coders should let the physician decide whether the procedure is simple or extensive.

Cryosurgery is another method physicians use to remove penile lesions. For simple destruction, use 54056 (Destruction of lesion[s], penis [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; cryosurgery) to report a liquid nitrogen treatment for these lesions.