Query: Complicated Verruca Treatment
The patient had a large plantar verruca that we chose to excise in the operating room. The lesion was at the left foot and the total size of excised area was 2.5 cm x 2.5 cm x 0.2 cm depth (including some subcutaneous tissue). The site was debrided and prepared for grafting. I applied a Grafix graft. Can I bill the preparation of wound bed? Can I use CPT 15004? What other options are there for billing this plantar verruca removal and graft application?
Codingline Archive
Response: There is no indication as to the insurance carrier involved as each may have their own rules on the use of products such as Grafix. There is also no indication as to the medical condition of the patient. Is this a healthy young person or a debilitated person? Products such as Grafix tend to be covered for certain wounds, primarily diabetic or venous leg ulcer/wounds. Yes, indications for products can expand over time as new indications are found.
With any wound, there is a potential for the wound to heal on its own accord. It may take a combination of local care, offloading, dressing, antibiotic therapy, etc. to get the wound to heal. When it does not heal, then other modalities such as skin substitutes may come into play. These products are expensive and should be used judiciously. Ultimately, taxpayers pay for these products. The first issue is why is ANY skin substitute required in this case versus just allowing the wound to heal on its own? How much faster will this wound heal with or without the graft? Is there literature proof?
Secondly, wound preparation is removing nonviable tissue (infected, non-viable, etc.) to have a clean, vascular base to then add a skin substitute. In this case, the only “prep” is removing the wart which you were paid for. What else was done beyond that? Is it the standard of care to use skin subs for warts or any other non-wound procedures we perform? This is what you must prove in your charting.
