Query: Treating a Pyogenic Granuloma
I applied sliver nitrate to a pyogenic granuloma, and wondered how it should be billed. After the application of silver nitrate, the granuloma was removed, and additional silver nitrate was applied to the lesion base. Any advice would be appreciated.
Daniel R. Brown, DPM , Herrin, IL
Response: CPT 17250 is chemical cauterization of granulation tissue [proud flesh, sinus or fistula].
If performing a nail avulsion/matrixectomy on a nail margin also containing a pyogenic granuloma, the application of silver nitrate would be incidental to the nail procedure.
If you are treating a pyogenic granuloma as a "separate procedure," and the payer has no policy requiring cauterization agents stronger than silver nitrate, you would bill CPT 17250.
Tony Poggio, DPM, Alameda, CA
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