Coding Cues

August 3, 2007

Answers to your questions about...a consult within a group; plantar warts; Holter monitors; adhesive strip repair

Key Points

A consult within a group

I'm part of an internal medicine group. I have a surgical background that my colleagues don't, so sometimes they send their patients to me for consultations on skin lesions, hemorrhoids, or large lipomas. Can I submit consultation codes for these initial visits?

Yes, as long as your colleagues clearly don't have your expertise. Members of a group can request a consultation from a colleague within the group if the consulting physician has skills and knowledge that go beyond the referring physicians'. But CMS has warned that this practice shouldn't be a routine occurrence. And remember that you still have to adhere to the requirements of a consult when you submit a claim for the visit. Both you and the requesting physician must document the medically necessary reason and request for the consult. And after you see and evaluate the patient, you must give the requesting physician your report. If you're sharing a group chart, your report in that chart should suffice.

I used cryotherapy to treat a patient's plantar wart. Am I supposed to submit 17000 or 17110?

Use 17110. In the past, you'd have used 17000-17004 for plantar wart removal, but revisions to those CPT codes this year mean that now you should use 17110 (destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement] of benign lesions other than skin tags or cutaneous vascular lesions; up to 14) or 17111 (15 or more lesions).

Codes 17000-17004 were revised to limit their use for reporting the destruction of premalignant lesions. Codes 17110 and 17111 were changed so they could be used to report destruction of benign lesions. And because plantar warts aren't considered to be of a premalignant nature and are considered benign, you'd use 17110 or 17111, depending on the number of warts that are removed.

Holter monitors

I've just started to use Holter monitors, but I don't do the scanning analysis. A colleague says I should add modifier –26 to 93224 when I submit a claim for the Holter monitor testing. Is that necessary?

No. Modifier –26 (professional component) shouldn't be appended to CPT code 93224 (electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage . . . ). You'd use this global code if you performed all of the described services. But if you don't, there are other Holter monitor codes that break out the individual components of the test; you'd bill for only the services that you provide. You'd submit 93225 (recording [including hook-up, recording, and disconnection] ) for the actual recording process, and 93227 (physician review and interpretation) for your supervision and interpretation of the results. The scanning company would report 93226 (scanning analysis with report).

Adhesive strip repair

I used Steri-Strips to close a wound on my patient's arm. What repair code should I use?

There isn't any CPT code for a simple wound closure using only adhesive strips. Codes 12001-13160-for simple, intermediate, or complex repairs-are for wound closures using sutures, staples, or tissue adhesives such as Dermabond, either by themselves or in some combination. But repairing a laceration with adhesive strips shouldn't be coded as a repair. You should include the application in the appropriate E&M code you report for the visit.

The author, Barbara F. Halenar, is an associate editor of Medical Economics. She is a member of the American Academy of Professional Coders.