08/02/2002 Dennis Frisch, DPM
Coding Enucleation of Porokeratotic Lesions
Query: Coding Enucleation of Porokeratotic
Lesions
From: Dennis Frisch, DPM
I would be interested in the opinion of others
as to coding enucleation of porokeratotic
lesions (small painful keratotic lesions that
need to be carefully "cored out"...and,
unfortunately, often return).
How does one code the "coring out" of one
lesion? Multiple lesions? Thanks.
Dennis Frisch, DPM
Boca Raton, FL
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Codingline(L) Reponse:
Porokeratosis plantaris discreta (porokeratosis)
is a seed-like hyperkeratotic lesion which may
be found on the soles. These lesions may be
isolated or grouped. If located under a
weightbearing segment of the foot, porokeratotic
lesions can be quite painful. First reported by
Marvin Steinberg, DPM and Jacob Taub, MD, these
keratotic lesions are common referred to
as "plugged duct cysts". One of the striking
features of the "porokeratosis" is a dilated
eccrine sweat gland deep in the dermis which
does not penetrate the epidermis in
histopathologic studies.
The treatments include palliative care,
intralesional injections of vitamin A,
cryosurgery, and surgical excision, among
others.
Your question appears to be centered on billing
palliative - non-definitive treatment - of
porokeratotic lesions. As you noted, these
lesions when debrided often return.
The choice of coding is third party payer-
dependent in most cases. Because the lesions are
located within the skin tissue, debridement or
paring are not full thickness. I would recommend
coding,
CPT 11055 (CPT 11056, CPT 11057) - paring or
cutting of benign hyperkeratotic lesion(s), if,
in fact, you are paring or cutting [for the
patient's temporary comfort] the porokeratotic
lesion; or
CPT 11040 - debridement; skin, partial
thickness, if you are removing "significiant"
lesion bulk ("coring out"), but not excising the
lesion. Again, this is for the patient's
temporary comfort, and is generally not
expected, by itself, to be definitive treatment;
or
CPT 17000 (CPT 17003, CPT 17004) - destruction
(eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), benign
lesion. This is an attempt at definitive care.
Obviously, after several "destruction" attempts,
if the lesion remains or recurs, it would be
good medical practice - if destruction is your
goal - to alter your treatment otherwise
the "destruction" procedure becomes no more than
a palliative care of the lesion [for the
patient's temporary comfort] - and your code
would need to change.
The reason I mentioned the "choice of coding is
third party payer-dependent" is simply that each
payer determines if the procedure performed is a
policy benefit, and which, if any, procedure
code it will recognize. Check with the
individual payer to see about coverage - and
don't be surprised if the palliative treatment
of porokeratotic lesions are considered the same
as the palliative treatment of nails and
calluses.
Harry Goldsmith, DPM – Codingline(L) Expert
Panelist
Cerritos, CA
