Wiki Excision of Genital Warts

[ELBrock]

Op Report

Procedure: Wide local excision of genital warts

Findings: Multiple genital warts, some were very thickened with wide bases, not amenable to laser or treatment with TCA or cryotherapy. Very large 2X2 thickened warts in the perineum, one on the left and one on the right. Other, smaller warts around the perineum. Ulcerative lesion on the right labia

Anesthesia: General

** Each wart was grasped with toothed forcep and a wide local excision performed using scalpel. Multiple warts removed, in total about 8. Sent for pathology. 3-4 were in the right labia area. Some bleeding noted after excision; controlled with pressure and use of silver nitrate sticks and interrupted sutures using 3-0 monocryl. The 2 larger warts had wide bases and therefore the dead space was closed with interrupted sutures of 3-0 vicryl to minimize tension on skin. Skin edges were reapproximated in a subcuticular fashion using 3-0 vicryl. We did not use Bovie.

Path Report: 7 specimen: 6 returned as "Benign condyloma with HPV associated changes", one as "Ulcer biopsy, nonspecific ulceration"

My Question: In order to code this with the Excision codes, I would need to query the provider for the exact number and measurements of the lesions and the excised margins, correct? The Op Report makes it sound like the provider did not take this data down.

 

[csperoni]

Yes, excision codes need the size documented. It is certainly not ideal, but I have been known to use the size from the pathology. I know that the specimen can shrink after excision, but if the provider doesn't recall, it is better than nothing.
I would educate the provider for future cases to document the precise number and size of the lesions and margins.

 

[ELBrock]

Yes, excision codes need the size documented. It is certainly not ideal, but I have been known to use the size from the pathology. I know that the specimen can shrink after excision, but if the provider doesn't recall, it is better than nothing.
I would educate the provider for future cases to document the precise number and size of the lesions and margins.

Thank you very much! I’ll have to review the pathology report to see if the measurements for each lesion is documented. Is there anything I would be able to bill if the size for the lesions is not available? I’d hate to see this service go un-billed. Thanks again!

 

[csperoni]

I've never seen a final pathology report without the sizes. That's always my last resort.

 

[ELBrock]

I've never seen a final pathology report without the sizes. That's always my last resort.

Thank you csperoni! I reviewed the Pathology Report this morning and yes, it does give the measurements of the lesions. There are two lesions that state "Multiple portions of soft tissue" were received and had measurements ranging from 0.3-0.5 cm. I guess in that case, you would use the largest measurement? I will have to inform the provider that next time, we need the measurement of the lesion and the margins of the excision. Thank you again!