Plantar Warts Excision

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I am having a hard time with this report. It looks like the Dr excised the warts individually and then used the CO2 laser after the excision instead of suturing to close them. Of course there is a drastic difference in reimbursement between plain destruction (17110/17111) and the excision (11420-11424). I feel like since the warts were all excised idividually, we should code for excision of benign lesion, but I would appreciate a second opinion. It's the "excised in total" and "sharp dissection" part that makes me think 11420-11424. Here is the wording of the report:

DESCRIPTION OF PROCEDURE: Patient was brought to the operating room and placed onto the operating table in the supine position, and 2 G of Ancef was given preoperatively. Following successful IV sedation, local was obtained about the patient’s left and right ankles and feet. There was initially a tibial block using 10 mL of 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain to the left and right ankles, and then local blocks 10 mL to the right plantar foot, 1% lidocaine with epinephrine into the right foot, and 20 mL of 1% lidocaine with epinephrine to the right foot, local blocks around these plantar warts. The left and right lower extremities were scrubbed, prepped, and draped in the usual aseptic manner. The left lower extremity was then elevated for approximately 2 minutes. An Esmarch bandage was used to exsanguinate. The pneumatic ankle tourniquet was then inflated at 250 mmHg.

Attention was then directed at the left plantar foot, where a circular incision was made along the plantar verruca, excised in total, sent for pathological analysis. The CO2 carbon dioxide laser, then phenol alcohol, bacitracin on Adaptic, 4 x 4's, Kling, ABD pad and Co-Flex wrap were applied to the patient's left ankle. The warts on the left side, there were seven clusters in total. Four verruca were 0.5 cm or smaller and two verruca were 0.6-1.0 cm and one verruca was 1.5 cm in total with seven total on the left side. On the right foot, preoperatively treated the same way. All of the clusters were excised in total utilizing sharp dissection. CO2 laser, then phenol, then alcohol, then bacitracin on Adaptic, then the right foot was then dressed with a sterile dressing consisting of bacitracin ointment on Adaptic, 4 x 4's, Kling, ABD pad, Kerlix, and a Co-Flex wrap. On the right plantar foot, 24 clusters of warts in total, ten were 0.5 cm and smaller, six were 0.6 cm to 1.0 cm in total, two were 1.1 cm to 2.0 cm in total, and four were 2.1 cm x 3 cm in total, and two were 3.1 cm x 4.0 cm in total to complete a total of 24 clusters on the right side and 7 clusters on the left side. All areas were dressed with sterile dressings. Both pneumatic ankle tourniquets were deflated. The left ankle tourniquet was on for approximately 25 minutes. The right ankle tourniquet was on for approximately 45 minutes.

The patient tolerated the procedure and anesthesia well. He was transported to the recovery room with vital signs stable and vascular status intact to the left and right lower extremities. Following a period of postoperative monitoring, the patient will be allowed to go home with the following written and oral instructions:

1. Keep dressings clean, dry, and intact.
2. Avoid excessive ambulation.
3. Weightbearing as tolerated with surgical shoes only.
4. Take prescription medication as directed.
5. Follow up in the office and to call with any problems, questions, or concerns


I code for the ASC, not the doctor.
 

Henson65

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Best answers
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I am having a hard time with this report. It looks like the Dr excised the warts individually and then used the CO2 laser after the excision instead of suturing to close them. Of course there is a drastic difference in reimbursement between plain destruction (17110/17111) and the excision (11420-11424). I feel like since the warts were all excised idividually, we should code for excision of benign lesion, but I would appreciate a second opinion. It's the "excised in total" and "sharp dissection" part that makes me think 11420-11424. Here is the wording of the report:

DESCRIPTION OF PROCEDURE: Patient was brought to the operating room and placed onto the operating table in the supine position, and 2 G of Ancef was given preoperatively. Following successful IV sedation, local was obtained about the patient’s left and right ankles and feet. There was initially a tibial block using 10 mL of 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain to the left and right ankles, and then local blocks 10 mL to the right plantar foot, 1% lidocaine with epinephrine into the right foot, and 20 mL of 1% lidocaine with epinephrine to the right foot, local blocks around these plantar warts. The left and right lower extremities were scrubbed, prepped, and draped in the usual aseptic manner. The left lower extremity was then elevated for approximately 2 minutes. An Esmarch bandage was used to exsanguinate. The pneumatic ankle tourniquet was then inflated at 250 mmHg.

Attention was then directed at the left plantar foot, where a circular incision was made along the plantar verruca, excised in total, sent for pathological analysis. The CO2 carbon dioxide laser, then phenol alcohol, bacitracin on Adaptic, 4 x 4's, Kling, ABD pad and Co-Flex wrap were applied to the patient's left ankle. The warts on the left side, there were seven clusters in total. Four verruca were 0.5 cm or smaller and two verruca were 0.6-1.0 cm and one verruca was 1.5 cm in total with seven total on the left side. On the right foot, preoperatively treated the same way. All of the clusters were excised in total utilizing sharp dissection. CO2 laser, then phenol, then alcohol, then bacitracin on Adaptic, then the right foot was then dressed with a sterile dressing consisting of bacitracin ointment on Adaptic, 4 x 4's, Kling, ABD pad, Kerlix, and a Co-Flex wrap. On the right plantar foot, 24 clusters of warts in total, ten were 0.5 cm and smaller, six were 0.6 cm to 1.0 cm in total, two were 1.1 cm to 2.0 cm in total, and four were 2.1 cm x 3 cm in total, and two were 3.1 cm x 4.0 cm in total to complete a total of 24 clusters on the right side and 7 clusters on the left side. All areas were dressed with sterile dressings. Both pneumatic ankle tourniquets were deflated. The left ankle tourniquet was on for approximately 25 minutes. The right ankle tourniquet was on for approximately 45 minutes.

The patient tolerated the procedure and anesthesia well. He was transported to the recovery room with vital signs stable and vascular status intact to the left and right lower extremities. Following a period of postoperative monitoring, the patient will be allowed to go home with the following written and oral instructions:

1. Keep dressings clean, dry, and intact.
2. Avoid excessive ambulation.
3. Weightbearing as tolerated with surgical shoes only.
4. Take prescription medication as directed.
5. Follow up in the office and to call with any problems, questions, or concerns


I code for the ASC, not the doctor.
I would code these as excisions 11420-11424.....since he mentions they were all excised as the primary treatment of the areas.
 
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