03/11/2003    Joy Williams

Coding For Pyogenic Granuloma

Query: Coding For Pyogenic Granuloma
From: Joy Williams

What is the proper coding for removal of a
pyogenic granuloma that developed post-phenol
nail matrixectomy? Thanks in advance.

Joy Williams
Nashville, TN

Codingline-L Responses:

It's my opinion that this can be handled in
two ways, depending on what was actually done.
Consider using one of the debridment codes, CPT
11040 - CPT 11042, depending upon the depth of
debridement.
If you actually excised tissue full-
thickness under anesthesia, use one of the
excision codes, CPT 11420 - CPT 11426, dependent
upon the actual size of tissue removed.

Howard Zlotoff, DPM - Codingline-L contributor
Camp Hill, PA

There are different ways to code the removal
of a pyogenic granuloma, depending on the
procedure utilized by the doctor. If the
granuloma was sharply excised, then use CPT
11420 - CPT 11426 (excision of benign lesion -
coded by size).
If the granuloma was shaved (defined
as "sharp removal by transverse incision or
horizontal slicing"), then use CPT 11305 - CPT
11308.
If the granuloma was cauterized
(electrical, chemical, etc.), use CPT 17250.

Mark Schilansky, DPM- Codingline-L Expert Panelist
Catskill NY

There are several issues to consider, including:
1) How long post-op was it that the granuloma
developed - i.e., is it still in the global
period?
2) What procedure was actually done to treat the
granuloma? Was it excised versus cauterized?
3) How large and problematic was the granuloma?
This would affect medical necessity for treatment
and reasonableness of the procedure chosen.
Because of definitional casualness by some
providers, it would be important to distinguish a
true pyogenic granuloma from other granulation
tissue.

Tony Poggio, DPM- Codingline-L Expert Panelist
Alameda, CA

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