Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure?
A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the code represents 1 to 14 lesions.

In a case in which more than 14 lesions are removed, you would bill CPT codes 17110and 17111, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions.” CPT code 17110 would be billed for the first 14 lesions, and CPT code 17111 would be billed to include any additional wart ablations.

Q. We used a digital block instead of a topical anesthetic when we performed a laceration repair. Can this nerve block be billed separately, or is it part of the repair? Also, because this was a simple repair and there is no global period, can we bill for the removal of sutures when the patient needs them removed?
A. A digital block is part of the laceration repair, as part of the surgical package. CPT guidelines define standards for preoperative and postoperative services that are included in the surgical package as follows:

  • Evaluation and management (E/M) service(s) subsequent to the decision for surgery on the day before and/or the day of surgery (including the medical history and physical examination)
  • Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia
  • Immediate postoperative care, including dictating surgery notes and talking with the family and other physicians or other qualified health-care professionals
  • Writing orders
  • Evaluating the patient in the postanesthesia recovery area
  • Typical postoperative follow-up care for the full length of the applicable global period

The guidelines of the Centers for Medicare & Medicaid Services (CMS) go a bit further than CPT guidelines to include the following postoperative services in their surgical package:

  • All additional medical or surgical services required of the practitioner to deal with complications that do not require more trips to the operating room
  • Follow-up visits that are related to recovery from the surgery
  • Postoperative pain management
  • Supplies, except for those identified as exclusions
  • Miscellaneous services, such as dressing changes; local incision care; removal of a surgery pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, and nasogastric and rectal tubes; and changes and removal of tracheostomy tubes

You can find more information about the CMS surgical package guidelines at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ downloads/GloballSurgery-ICN907166.pdf.
DAVID STERN, MD (Practice Velocity)

Plantar Warts, Digital Nerve Block in Lacerations, and Established Patients

David Stern, MD

Chief Executive Officer at Practice Velocity Urgent Care Solutions, Founding Member of the Urgent Care Association of America, Publishing Staff for The Journal of Urgent Care Medicine
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