11/18/2021

Correct Billing for Pre-Ulcerative Lesion with Subdermal Blood and Skin Breakdown

How do you appropriately bill for a pre-ulcerative lesion with subdermal blood and skin break down. Is there an ulceration code that belongs with that and then can you bill a 97597 or is it just a callous debridement (1105X) if they have the appropriate other primary diagnoses?

Pre-ulcerative lesions are considered an unspecified diagnosis where there is no ulcer ICD-10 code that would be appropriate to bill. Based on the two criteria listed below, the most appropriate diagnosis code to bill would be L98.8 (Disorder of the skin and subcutaneous tissue, unspecified). With this diagnosis, it would not be appropriate to bill for a wound debridement since an ulcer diagnosis and its corresponding stage is not being reported. It would also be inappropriate to bill for 11055-11057 since the lesion in question is not a corn or callus. If a minor procedure is being performed on the area in question, it would depend on the method of treatment: 

• Biopsy (11102-11107, depending on the method)
• Shave (11305-11308, depending on size)
• Surgical excision (11420-11426)