Primary Care Coding Alert

Reviewed on May 22, 2015 Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How should I code for removal of genital warts?
  Answer: Genital warts, like other gynecological lesions, can be removed one of two ways through excision or destruction. With routine and recurrent vaginal warts, destruction is the most common method of removal. Coders should assign either 57061 (Destruction of vaginal lesion[s]; simple [e.g, laser surgery, electrosurgery, cryosurgery, chemosurgery]) or 57065 (…extensive…) When a lesion is excised, it is cut away from the surrounding tissue and sometimes biopsied. Destruction involves breaking down the lesion by any number of methods, including chemical and laser treatment, electro- and cryosurgery, during which the lesion is frozen off using liquid nitrogen or carbon dioxide. The tissue of the lesion is destroyed, and no biopsy is conducted.

The difference between simple and extensive comes down to the clinical judgment of the physician, who may consider factors like the number and size of the warts. Coding experts advise that if the patient has more than two vaginal warts, 57065 would be warranted. In addition, if the warts are large and significantly raised off the skin surface, and require more time or chemicals to remove, the code for extensive destruction might also apply. 

Also, coders would choose from the following diagnosis codes, depending on the patients symptoms:

078.10 viral warts, unspecified

078.11 condyloma acuminatum 

078.19 other specified viral warts (includes genital warts NOS)

091.3 secondary syphilis of skin or mucous membranes (includes condyloma latum)

Also, the human papillomavirus causing the warts needs to be identified as the viral agent and coded 079.4 (human papillomavirus). This serves as the secondary diagnosis to the code for the lesion. ICD-10: When you begin using ICD-10 codes, your reporting of the above mentioned ICD-9 codes will change to the following: B07.9 (Viral wart, unspecified) instead of 078.10 A63.0 (Anogenital [venereal] warts) instead of 078.11 B07.8 (Other viral warts) instead of 078.19 A51.31 (Condyloma latum) or A51.39 (Other secondary syphilis of skin) instead of 091.3 B97.7 (Papillomavirus as the cause of diseases classified elsewhere) instead of 079.4