Coding genital lesions: Optimize payment by specifying body area when billing for your services

October 1, 2008

Treating lesions of the vulva, anus and penis is common practice in dermatology, yet many dermatologists misrepresent the CPT code(s), as they are not aware that there are specific codes for some of these areas that have significantly higher allowables.

Treating lesions of the vulva, anus and penis is common practice in dermatology, yet many dermatologists misrepresent the CPT code(s), as they are not aware that there are specific codes for some of these areas that have significantly higher allowables.

In this article, I will answer some of the many questions I receive about the billing of these types of services and how you can optimize payment.

Q When I perform a biopsy of the perirectal or perianal region, is there a biopsy code other than CPT code 11100?

Q I was an infectious disease physician and then became a dermatologist. Consequently, I treat a lot of patients with genital warts. If a patient has numerous warts, and I treat those using different methods, can I bill more than one method on the same date of service? My billing staff tells me they have a lot of trouble when I bill that way.

A First, we need to review some of the more frequently used methods and what CPT codes should be used when these methods are used to treat genital warts. Then I will need to clarify your question, as I am not sure I understand exactly what you mean.

The different methods of treatment and appropriate codes are:

1. Podofilox or imiquimod prescriptions - a prescription medication applied to the surface of the warts.

How to code:

This is a prescription medication that is applied by the patient. There is no way to bill for this service. It is part of the E/M service and is not billable separately.

2. Podophyllin - a chemical applied to the surface of warts by a healthcare provider.

How to code:

Anus: 46900 (for simple treatment - few lesions), 46924 (for extensive treatment - large number of lesions or complicated)

Penis: 54050 (for simple treatment - few lesions), 54065 (for extensive treatment - large number of lesions or complicated)

Vulva: 56501 (for simple treatment - few lesions), 56515 (for extensive treatment - large number of lesions or complicated)

3. Trichloroacetic acid (TCA) - an acid that is applied by the healthcare professional to the wart and surrounding tissue to destroy wart tissue. This procedure burns slightly, and the skin will turn white as it is applied, resulting in a sore that quickly heals.

How to code: Same as above for podophyllin

4. Cryosurgery - a procedure in which liquid nitrogen is placed on the wart and a small area of surrounding skin. The liquid nitrogen freezes the skin, resulting in ice crystals that slough the wart.

How to code:

Anus: 46916 (for simple treatment - few lesions), 46924 (for extensive treatment - large number of lesions or complicated)

Penis: 54056 (for simple treatment - few lesions), 54065 (for extensive treatment - large number of lesions or complicated)

Vulva: 56501 (for simple treatment - few lesions), 56515 (for extensive treatment - large number of lesions or complicated)

5. Interferon - an antiviral drug that is injected into the warts intralesionally to boost the immune reaction and cause rejection of the wart.

How to code:

11900 for up to seven lesions

11901 for more than seven lesions

Plus the J-code for interferon:

J9213: Interferon, alfa-2a, recombinant, 3 million units

J9214: Interferon, alfa-2b, recombinant, 1 million units

J9215: Interferon, alfa-n3, (human leukocyte-derived), 250,000 iu

J9216: Interferon, gamma 1-b, 3 million units