APMA News - June 2012 - (Page 26)

Reimbursement By Harry Goldsmith, DPM Shaving of Epidermal or Dermal Lesions Ever since their inclusion in CPT, the “shaving of epidermal or dermal lesion” codes have tempted some podiatrists to substitute them for the paring or cutting of hyperkeratotic lesion codes. Using CPT 11305-11308 as a repetitive palliative service (i.e., routine foot care) is a misrepresentation of what these codes signify. Regardless of the reason (to avoid hassle or for financial gain), billing the shaving of epidermal or dermal lesion codes for routine foot care services (“the cutting or removal of corns and calluses”) is absolutely wrong. CPT provides coding guidelines for CPT 11300-11308 by defining the procedure: “Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization of the wound. The wound does not require suture closure.” The February 2008 CPT Assistant featured an article on “Shaving of Epidermal or Dermal Lesions” that gave some additional information to help clarify the purpose of the codes. Here are some excerpts: “A shave removal is a distinct procedure.” “Removal of tissue does not necessarily constitute a biopsy, and, therefore, should not be coded as a [biopsy].” “A shave removal is not considered an excision, and excision codes should not be used to report these services.” “The removal of a lesion by the shave technique requires a superficial removal but does not require complete removal of a lesion.” “Whether a lesion is completely removed by the shave technique depends on its location and depth within the skin.” “CPT codes 11300-[11308], which are defined by the shaving technique used to remove the lesion, may be reported for either benign or malignant lesions.” “Select the appropriate code from the 11300-[11308] series based on anatomic site and the largest diameter size of the lesion itself, not including any additional margin.” “Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed. Report separately each benign lesion excised. Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter). The margins refer to the most narrow margin required to adequately excise the lesion, based on the physician’s judgment. The measurement of lesion plus margin is made prior to excision.” In 2008, CPT unfortunately did not help to clarify the use of the shave codes by including the following in the “Biopsy” section guidelines: “During certain surgical procedures in the integumentary system, such as excision, destruction, or shave removals, the removed tissue is often submitted for pathologic examination.” Apparently, coders saw “shave removals” in the above guidelines and assumed that if you performed a shave procedure and submitted the specimen for laboratory examination, you could code CPT 11100 instead of a code from the CPT 11300-11308 code series. That was wrong. Sending a specimen to pathology is not the determiner of which coding series to use. The procedure intent is the determiner. For example, if the shave procedure was performed primarily to remove the lesion, and the doctor secondarily submitted it to pathology for examination, the procedure is billed using the appropriate shaving of epidermal or dermal lesion code. If, however, the primary purpose of the shave removal was to obtain a specimen for biopsy, then CPT 11100 (biopsy of skin) would be billed. It should be noted that neither the fact that the tissue submitted is a “shaved specimen of skin” nor the findings of the pathology exam influence the procedure coding. The medical record should clearly evidence the reason for the shave removal procedure. Documented fi ndings/complaints like “symptomatic plaque” or “raised lesion irritated by sock” support the “therapeutic intent” of the shave procedure. Obviously, objective/subjective fi ndings describing the lesion—location, size, changes in size over time, color, raised or not, any limiting factors, symptoms—should be documented. The take-home point is that the shave codes are not to be used for the palliative debridement of hyperkeratotic lesions typically performed by podiatrists. For additional details, see the extended version of this article on the APMA website at www.apma.org/shavearticle. n • • • • • • • To this last point, measure the largest diameter size of the lesion (if irregular in shape, pick the portion of the lesion with the greatest diameter), then refer to the CPT shave codes, under the appropriate anatomic procedure site, and find the proper code. These instructions are different from those given for measuring and determining the appropriate code for excision of benign lesions (CPT 11400-11426) and excision of malignant lesions (CPT 11600-11626). The instructions for these excision codes read as follows: 26 APMA News June 2012 Contact Dr. Goldsmith at healthpolicy.hpp@apma.org. http://www.apma.org

Table of Contents for the Digital Edition of APMA News - June 2012

APMA News - June 2012
President’s Message
Contents
APMA Introduces REdRC
Legislative Scrapbook
APMA By the Decade
Profiles in Progress
2011 Podiatric Practice Survey
Reimbursement
Federal Advocacy Forum
List of Cosponsors to the Equity and Access for Podiatric Physicians Under Medicaid Act
APMAPAC Chair Report
IT Consultant
Website Wisdom
Technofile
Small Business 101
CPME Update
Pediatric Medical Assistans' Education Program
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Sponsors
Annual Scientific Meeting Registration Form
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
APMAPAC Update
Development Update
Call for Third-party Comments
Classified Advertising
Dates to Remember
Advertising Index
Your APMA

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