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cryosurgical wart removal

the same thing as you describe only i still use typical Qtips -- it gives me greater control of where I am freezing and keeps the "1mm" of normal tissue frozen to a minimum

I have heard and tried the pelvic exam swabs, but have reverted back to regular Q-tips

mark

>
> From: Julia Mason
> Date: 2007/09/07 Fri AM 10:02:43 EST
> To: PedTalk
> Subject: Re: cryosurgical wart removal
>
> Pulling this out of the previous conversation. . .
>
> On Sep 7, 2007, at 7:58 AM, Ari Eisenberg wrote:
>
> > A prime example of
> > a doctor with "advanced training" is: cryosurgical wart removal. Is
> > everyone taught to do this in med school, or is this a skill that is
> > learned later -- I know we have made removed a large number of
> > warts in
> > our office. I know way back when before the advent of Histofreeze and
> > Varuca freeze this was the purview of the dermatologist.
>
> O.K., now I'm curious. In med school I learned to freeze warts with
> q-tips dipped in liquid nitrogen. I learned in the public health
> clinic, treating genital warts primarily. Now that I'm in practice,
> we still use q-tips and liquid nitrogen (although I've taught
> everyone to use the giant pelvic-exam cotton swabs for plantar warts--
> I roll the tip to make a smaller "point"). I'm happy with the
> results I get, and I don't think the materials are all that
> expensive, once we purchased the liquid nitrogen container.
>
> Just this past Tuesday I treated my youngest patient so far, a two
> and a half year old girl with a plantar wart. Her mother was
> skeptical that she would hold still (so why did she bring her in?),
> but by starting slow (holding the cold swab to the wart just briefly)
> and working my way up to longer time periods, I was eventually able
> to get three significant freezes (for me, that means that the
> "snowball" look/frozen area goes at least a couple of milimeters
> beyond the border of the wart itself). We'll see if it worked, but
> I'm hopeful.
>
> What are other people doing in their offices? Wart treatments are
> fascinating, as they seem to be quite susceptible to the placebo
> effect (witness all the magical wart treatments out there).
>
> Julia in Wisconsin

RE: cryosurgical wart removal

Message from Kevin M. Windisch MD, FAAP hidden@email-address

I use cantharadin or cantharadin plus podoflox. The application is quick
and painless for the patient. The ensuing blister can hurt but is no more
painful than the blister from liquid N2.

kmw

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address] On Behalf Of
hidden@email-address
Sent: Friday, September 07, 2007 7:18 AM
To: hidden@email-address
Subject: Re: cryosurgical wart removal

the same thing as you describe only i still use typical Qtips -- it gives me
greater control of where I am freezing and keeps the "1mm" of normal tissue
frozen to a minimum

I have heard and tried the pelvic exam swabs, but have reverted back to
regular Q-tips

mark

>
> From: Julia Mason
> Date: 2007/09/07 Fri AM 10:02:43 EST
> To: PedTalk
> Subject: Re: cryosurgical wart removal
>
> Pulling this out of the previous conversation. . .
>
> On Sep 7, 2007, at 7:58 AM, Ari Eisenberg wrote:
>
> > A prime example of
> > a doctor with "advanced training" is: cryosurgical wart removal. Is
> > everyone taught to do this in med school, or is this a skill that is
> > learned later -- I know we have made removed a large number of
> > warts in
> > our office. I know way back when before the advent of Histofreeze and
> > Varuca freeze this was the purview of the dermatologist.
>
> O.K., now I'm curious. In med school I learned to freeze warts with
> q-tips dipped in liquid nitrogen. I learned in the public health
> clinic, treating genital warts primarily. Now that I'm in practice,
> we still use q-tips and liquid nitrogen (although I've taught
> everyone to use the giant pelvic-exam cotton swabs for plantar warts--
> I roll the tip to make a smaller "point"). I'm happy with the
> results I get, and I don't think the materials are all that
> expensive, once we purchased the liquid nitrogen container.
>
> Just this past Tuesday I treated my youngest patient so far, a two
> and a half year old girl with a plantar wart. Her mother was
> skeptical that she would hold still (so why did she bring her in?),
> but by starting slow (holding the cold swab to the wart just briefly)
> and working my way up to longer time periods, I was eventually able
> to get three significant freezes (for me, that means that the
> "snowball" look/frozen area goes at least a couple of milimeters
> beyond the border of the wart itself). We'll see if it worked, but
> I'm hopeful.
>
> What are other people doing in their offices? Wart treatments are
> fascinating, as they seem to be quite susceptible to the placebo
> effect (witness all the magical wart treatments out there).
>
> Julia in Wisconsin

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Wart Removal

Does anyone know the code(s) for wart removal?

Can you bill by units?

Do you bill in addition to an ov with a modifier?

Thank You.
Allina
San Antonio, TX

Wart Removal

> Does anyone know the code(s) for wart removal?
>
> Can you bill by units?
>
> Do you bill in addition to an ov with a modifier?
>
> Thank You.
> Allina
> San Antonio, TX
>
Hi Allina,

We use code 17110 with the description of wart removal with cyrosurgery and
yes we also code an office visit with procedure.

--
- Paulette

hidden@email-address Paradise Pediatrics, P.C.
602-386-2119 (private line) 4626 E. Shea Blvd #C100
602-996-5516 (fax) Phoenix, Az 85028

Wart Removal

Hi, I have billed office visit plus 17110 wart removal
and gotten paid both procedures.

Wart Removal

Ditto but be sure & bill the OV with a modifier -25

Deb

Debbie MacLeod Children's Clinic of Owasso, P.C.
hidden@email-address 8291 N. Owasso Expressway
918-272-8989 or fax 918-272-4185 Owasso, OK 74055-3634

Wart Removal

> Hi Allina,
>
> We use code 17110 with the description of wart removal with cyrosurgery and
> yes we also code an office visit with procedure.

Does it make a difference if you burn 1 or 2
versus 20 or 30?

Would you bill the same or can you bill in units?

Somewhere along the way, before we started doing
this, I read that there was a code for less than
12 and a code for over 12???

Thank You
Allina
San Antonio, TX

Wart Removal-reply

I got a brochure titled "Getting Reimbursed for Cryosurgery"
from STC Technologies, Inc. Their phone # is 800-869-3538 or
610-882-1820 w/fax #610-882-1830...or www.STCTech.com or I'll
just type what you need to know. I was lost also until I found
this.

"As a service to our physicians and their staff, STC Technologies is pleased
to provide information that we hope will assist you in billing and reimbursementfor cyrosurgical procedures performed using the HISTOFREEZER PORTABLE CRYO-
SURGICAL SYSTEM.

Information provided is for example and comparison only. It does not represent
a guarantee or assurance that services will be considered or paid.

RECOMMENDED CPT CODES
For billing and reimbursement purposes, it is recommended that the following
CPT, as provided by the AMA be used: (Refer to Integumentary System Destruction
Benign or Premalignant Lesions). Indications for code use should include:
Verruca Vulgaris, Verruca Plantaris, Actinic Keratoses, Lentigo, and Seborrheic
Keratoses.

17000* Destruction by any method, including laser, with or without surgical
currettement, all benign or premalignant lesions (e.g., actinic
keratoses) other than skin tags or cutaneous vascular proliferative
lesions, including local anesthesia; first lesion.

17003 second through 14 lesions, each (List separately in addition to code
for first lesion)

17004 15 or more lesions

Code recommendation for Molluscum Contagiosum and Verruca Plana:

17110 Destruction by any method of flat warts, molluscum contagiosum, or
milia up to 14 lesions

17111 15 or more lesions

Code recommendation for Skin Tags (Acrochordon):

11200* Removal of skin tags, multiple fibrocutaneous tags, any area;
up to and including 15 lesions

11201 each additional ten lesions

* Payments varied depending on whether charges were submitted on a per lesion
or flat fee basis and vary from state-to-state.

It is important to note that appropriate diagnosis codes must be submitted
to substantiate medical necessity for the procedure. Additionally, the
appropriate modifer code must also accompany the respective CPT code to
insure payment where multiple lesions or second applications may occur.
Finally, adequate documentation of the procedure performed should be contained
in the patient's chart to substantiate the service billed.

The following is a list of modifer codes that may be used in conjunction
with CPT code submission.

Modifer Code Usage
------- ----------
-50 Subsequent lesion treated on both sides of the
body, same day
-51 Subsequent lesion or multiple procedure treated
on same side of the body, same day
-76 Repeat procedure by same physician
-77 Repeat procedure by fellow physician

WE RECOMMEND THAT OFFICES BILLING THESE PROCEDURE FOR THE FIRST TIME
DIRECT QUESTIONS TO THEIR CARRIER REPRESENTATIVES.

REPORTING PROCEDURES
--------------------
Reporting procedure described by codes 17000-17004 varies from carrier
to carrier, and in many cases is left up to the physician to interpret.
THE FOLLOWING EXAMPLES OF REPORTING METHODS ARE FOR ILLUSTRATION
PURPOSES ONLY AND SHOULD NOT BE ASSUMED TO BE ACCEPTABLE TO ALL CARRIERS,
but should be applicable in most circumstances.

Following is an example of one common method for reporting these procedures
to most common carriers:

No. of Lesions Use Codes:
-------------- ----------
1 17000
2 17000, and 17003-(50 to 51)
3 17000, and 17003-(50 or 51) X 2
4 through 14 17000, and 17003-(50 or 51) X 3....
15 or more 17000, and 17004-(50 or 51) X 1

REIMBURSEMENT RANGES
--------------------
Our research shows that the average ranges for reimbursement in 1997,
for procedures using the Histrofreezer system, across the United States, are:

CPT Code Blue Shield Medicare/Medicaid
17000 $50.00 $35.00
17003 $26.00 $9.67
17004 $20.00 $174.00"

Okay, I typed what I'd want to know...you want to know more info...call
that number I wrote down and the beginning. This brochure was just given
to me in May 2000 & has worked for me. The Ins Cos DO try to bundle the
procedures and I appeal & they come back & pay. I have even changed a
-25 OV with histrofreeze & they pay it. HOWEVER, it is a sometimes paid
as a global procedure if you do the histofreeze at multiple times and you
get either no payment or reduced payment.

Good Luck!
lucinda
Woodhill Pediatrics
Dallas, TX

>
>
> > Hi Allina,
> >
> > We use code 17110 with the description of wart removal with cyrosurgery and
> > yes we also code an office visit with procedure.
>
> Does it make a difference if you burn 1 or 2
> versus 20 or 30?
>
> Would you bill the same or can you bill in units?
>
> Somewhere along the way, before we started doing
> this, I read that there was a code for less than
> 12 and a code for over 12???
>
> Thank You
> Allina
> San Antonio, TX

Wart Removal

Hey All,

I would like to know how other physicians offices handle a charge for
a second cryosurgery for wart removal on the same wart. If the second
cryosurgery or even the third that is done after the 10 day global period for
the first cryosurgery do other offices charge? If the physician feels the
first cryosurgery was not aggressive enough and the second cryosurgery has
to be done are charges done for both? Is there any thoughts on not charging
for a repeat cryosurgery and if so what time frame is considered?

Any thoughts or comments on this would be greatly appreciated.

Thanks,

Judy Shoffner

Business Office
(865)525-0040

Wart Removal

I would charge for the second procedure if it is beyond the 10 days, there
is no promise the first procedure would work AND the cryo stuff does have
a real cost (although I do not know how many procedures with the different
sizes etc but a can is expensive!). Also with some insurance companies
you cannot charge an OV or collect a copay so this needs to be considered.
janieann @ppsc
On Tue, 20 Aug 2002, Judy P Shoffner wrote:

>
> Hey All,
>
> I would like to know how other physicians offices handle a charge for
> a second cryosurgery for wart removal on the same wart. If the second
> cryosurgery or even the third that is done after the 10 day global period for
> the first cryosurgery do other offices charge? If the physician feels the
> first cryosurgery was not aggressive enough and the second cryosurgery has
> to be done are charges done for both? Is there any thoughts on not charging
> for a repeat cryosurgery and if so what time frame is considered?
>
> Any thoughts or comments on this would be greatly appreciated.
>
>
> Thanks,
>
> Judy Shoffner
>
> Business Office
> (865)525-0040

Wart Removal

How many offices charge for a wart removal after the 10 day global
period..we have patients that come in for a wart removal after the 10 days
have expired for the same wart and we keep no charging them...I think we
should charge them - what do other offices do? Connie from Dr Eastman's
office...
_______________________________________________
PartnerTalk mailing list
hidden@email-address
http://www.pcc.com/mailman/listinfo/partnertalk

Wart Removal

There is a good pamphlet "compliments" of Verruca-Freeze, called
Cryosurgery: Solutions For Skin Lesions that tell you everything you need
to know about billing wart removal.
800-729-1624 or 615-354-0414 or fax 615-354-0466
www.cryosurgeryinc.com
email: hidden@email-address

Hope this helps ya'll

Debbie from Oklahoma

Debbie MacLeod Children's Clinic of Owasso, P.C.
hidden@email-address 8291 N. Owasso Expressway
918-272-8989 or fax 918-272-4185 Owasso, OK 74055-3634

On Fri, 11 Jan 2002, Allina Rumfelt wrote:

>
> > Hi Allina,
> >
> > We use code 17110 with the description of wart removal with cyrosurgery and
> > yes we also code an office visit with procedure.
>
> Does it make a difference if you burn 1 or 2
> versus 20 or 30?
>
> Would you bill the same or can you bill in units?
>
> Somewhere along the way, before we started doing
> this, I read that there was a code for less than
> 12 and a code for over 12???
>
> Thank You
> Allina
> San Antonio, TX

Wart Removal

> Does anyone know the code(s) for wart removal?
>
> Can you bill by units?
>
> Do you bill in addition to an ov with a modifier?
>
> Thank You.
> Allina
> San Antonio, TX
>
Hi Allina,

The code is 17110 wart destruction and yes we bill with the office visit
plus the modifier. You can also bill the wart desttruction by units,
some of the insurance carriers cover both and others only cover the wart
destruction. I hope this helps....

Bella Lieblich
WPPG

Wart Removal

Here are the codes we utilize for wart removal in our office. Warts are
classified into two groups, flat warts or molluscum contagiosum and common
warts (defined in the CPT book as benign or premalignant lesions other
than skin tags). Removal of flat warts utilizes CPT 17110 (x1) for up to
14 lesions, in other words, one to fourteen lesions. If more than 15 lesions
were removed, then one would use CPT 17111 (x1) for the removal.
For common warts, the coding is a little bit different. CPT code 17000 is
used for removal of the first lesion. If more than one is treated, then
you would use the "add-on" CPT code of 17003 (x1) for the second through
fourteenth lesions. If 15 or more common lesions are treated, then you
would use 17004 for the removal.

In the majority of these cases unless there is a separate and identifiable
evaluation and management service provided, we do not charge for an office
visit in addition to the wart removal codes. We do, however, charge an
E & M visit for recheck and retreatment of the same wart (within a
reasonable time frame).

On Fri, 11 Jan 2002, Allina Rumfelt wrote:

>
> Does anyone know the code(s) for wart removal?
>
> Can you bill by units?
>
> Do you bill in addition to an ov with a modifier?
>
> Thank You.
> Allina
> San Antonio, TX