para>Picture courtesy of Dr. Richard Usatine.View Original Step 3
Picture courtesy of Dr. Richard Usatine.
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Forceps Freeze for Small Pedunculated Lesions
Step 2
Pour liquid nitrogen into a disposable polystyrene cup as described previously. Cover the handle of the forceps with a folded 4- 4-inch gauze to protect the fingers. Then dip the forceps into the liquid nitrogen until it becomes frosted. Pinch the lesion between the tips of the cold forceps until it turns frosty white. Keep the forceps on for an additional 15 seconds and repeat.
- PEARL: Lesions will fall off within 1 week and usually heal without problems.
- PITFALL: This method is slow and primarily used when few lesions are present.
Step 2
Picture courtesy of Dr. Russell Roberts.
View Original Step 2
Picture courtesy of Dr. Russell Roberts.
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Complications
- Blister formation
- Edema
- Headache (after treatment of facial lesions)
- Pain
- Syncope (vasovagal; rare)
- Bleeding
- Excess granulation tissue formation (rare)
- Infection (rare)
- Atrophy (rare)
- Hypopigmentation
- Hyperpigmentation
- Hypertrophic scarring
- Milia
- Permanent hair loss
- Alteration of sensation
- Temporary, sensory nerve damage (rare)
Pediatric Considerations
This treatment is performed in a similar manner in pediatric populations. Consider a topical or injectable anesthetic for younger children, because they are often less tolerant of mild pain.
Postprocedure Instructions
Instruct the patient to keep the treated skin clean and to place an antibiotic ointment and bandage on the area after the blister breaks until the wound heals. Because the blister is a sterile bandage that provides moist healing, tell the patient to not open the blister and to allow it to rupture on its own. Have them call your office if the blister becomes painful or drains pus.
Coding Information and Supply Sources
Specific site treatment codes generally reimburse more than the general codes. Although 17000 and 17003 should be used together when appropriate, 17004 is a stand-alone code for any number beyond 14 lesions and is not use with 17000 or 17003.
Note the 17110 to 17111 "destruction of flat warts, molluscum, milia " codes were generalized to "benign lesions. " Destruction performed in certain locations such as penis and vulva can be billed using a specific site destruction code. Malignant lesion destruction (17260 to 17286) provides additional reimbursement when cancerous lesions are ablated.
Office gun applicators, tank units, and hand-held devices can be obtained from these suppliers:
- Wallach Surgical, 235 Edison Road, Orange, CT 06477. Phone: 203-799-2000. Web site: http://www.wallach.com/.
- Brymill Cryogenic Systems, 105 Windermere Avenue, Ellington, CT 06029-3858. Phone: 1-800-777-2796. Web site: http://www.brymill.com/.
- Delasco, 608 13th Avenue, Council Bluffs, IA 51501-6401. Phone: 1-800-831-6273; fax: 1-800-320-9612; e-mail: questions@delasco.com.website: http://www.delasco.com/pcat/1/Cryosurgery/.
View Large CPT Code Description 2008 Average 50th Percentile Fee Global Period 11200 Removal (any method) of up to 15 multiple tags, any area $126.00 10 11201 Removal of each additional 10 lesions (list separately) $61.00 ZZZ 17000 Destruction benign or premalignant lesion by any method, first lesion (may use with 17003) $102.00 10 17003 Destruction benign or premalignant lesion by any method, 2nd through 14th lesion (list 1 unit for each lesion) $35.00 ZZZ 17004 Destruction benign or premalignant lesion by any method, ≥15 lesions (do not use with 17000 or 17003) $366.00 10 17110 Destruction (laser, cryo, chemical, surgical) benign lesion other than skin tags or vascular lesions ≤14 lesions $124.00 10 17111 Destruction benign lesion other than skin tags or vascular lesions by any method, ≥15 lesions $147.00 10 17260 Destruction malignant lesion by any method TAL ≤0.5 cm $187.00 10 17261 Destruction malignant lesion by any method TAL 0.6 " 1 cm $242.00 10 17262 Destruction malignant lesion by any method TAL 1.1 " 2 cm $293.00 10 17263 Destruction malignant lesion by any method TAL 2.1 " 3 cm $334.00 10 17264 Destruction malignant lesion by any method TAL 3.1 " 4 cm $367.00 10 17266 Destruction malignant lesion by any method TAL >4 cm $429.00 10 17270 Destruction malignant lesion by any method SNHFG ≤0.5 cm $236.00 10 17271 Destruction malignant lesion by any method SNHFG 0.6 " 1 cm $287.00 10 17272 Destruction malignant lesion by any method SNHFG 1.1 " 2 cm $346.00 10 17273 Destruction malignant lesion by any method SNHFG 2.1 " 3 cm $396.00 10 17274 Destruction malignant lesion by any method SNHFG 3.1 " 4 cm $467.00 10 17276 Destruction malignant lesion by any method SNHFG >4 cm $550.00 10 17280 Destruction malignant lesion by any method FEENLM ≤0.5 cm $265.00 10 17281 Destruction malignant lesion by any method FEENLM 0.6 " 1 cm $344.00 10 17282 Destruction malignant lesion by any method FEENLM 1.1 " 2 cm $403.00 10 17283 Destruction malignant lesion by any method FEENLM 2.1 " 3 cm $486.00 10 17284 Destruction malignant lesion by any method FEENLM 3.1 " 4 cm $576.00 10 17286 Destruction malignant lesion by any method FEENLM >4 cm $718.00 10 46916 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery $424.00 10 46924 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (e.g., laser surgery, electro- surgery, cryosurgery, chemosurgery) $1,017.00 10 54050 Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical $245.00 10 54056 Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery $270.00 10 54065 Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (e.g., laser surgery, electro- surgery, cryosurgery, chemosurgery) $779.00 10 56501 Destruction of lesion(s), vulva; simple (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) $300.00 10 56515 Destruction of lesion(s), vulva; extensive (e.g., laser surgery, electro-surgery, cryosurgery, chemosurgery) $839.00 10 67850 Destruction of lesion of lid margin ( ≤1 cm) $472.00 10 ZZZ, Code related to another service and is always included in the global period of the other service.CPT is a registered trademark of the American Medical Association.2008 average 50th Percentile Fees are provided courtesy of 2008 MMH-SI 's copyrighted Physicians ' Fees and Coding Guide.TAL, trunk, arms, or legs; SNHFG, scalp, neck, hands, feet, or genitalia; FEENLM, face, ears, eyelids, nose, lips, or mucus membranes.
Bibliography
1
American Academy of Dermatology Committee on Guidelines of Care. Guidelines of care for cryosurgery.
J Am Acad Dermatol.
1994;31:648 " 653. 2
Andrews MD. Cryosurgery for common skin conditions.
Am Fam Physician
. 2004;69:2365 " 2372. [View Abstract]
3
Cooper C. Cryotherapy in general practice.
Practitioner.
2001;245:954 " 956. [View Abstract]
4
Cryomedics.
Guidelines for Cryosurgery
. Langhorne, PA: Cabot Medical; 1989. 5
Dawber RP. Cryosurgery: complications and contraindications.
Clin Dermatol.
1990;8:108 " 114. [View Abstract]
6
Dinehart SM. Actinic keratoses: scientific evaluation and public health implications.
J Am Acad Dermatol
. 2000;42:S25 " S28. 7
Graham GE. Advances in cryosurgery in the past decade.
Cutis
1993;52:365 " 372. [View Abstract]
8
Grealish RJ. Cryosurgery for benign skin lesions.
Fam Pract Recertification J.
1989;11:21 " 24. 9
Hocutt JE. Skin cryosurgery for the family physician.
Am Fam Physician.
1993;48:445 " 452. [View Abstract]
10
Kuflik EG: Cryosurgery updated.
J Am Acad Dermatol.
1994;31(6):925 " 944; quiz 944 " 946. 11
Kuflik EG. Cryosurgery for cutaneous malignancy: an update.
Dermatol Surg.
1997;23:1081 " 1087. [View Abstract]
12
Kuwahara RT, Huber JD, Shelley HR. Surgical pearl: forceps method for freezing benign lesion.
J Am Acad Dermatol.
2000;43:306 " 307. [View Abstract]
13
Orengo I, Salasche SJ: Surgical pearl: the cotton-tipped applicator " the ever-ready, multipurpose superstar.
J Am Acad Dermatol.
1994;31(4):658 " 660. [View Abstract]
14
Torre D. The art of cryosurgery.
Cutis
. 1994;54:354. [View Abstract]
15
Torre D. Cryosurgery of basal cell carcinoma.
J Am Acad Dermatol.
1986;15:917 " 929. [View Abstract]
16
Torre D. Cutaneous cryosurgery: current state of the art.
J Dermatol Surg Oncol.
1985;11:292 " 293. [View Abstract]
17
Zouboulis CC, Blume U, Buttner P, et al. Outcomes of cryosurgery in keloids and hypertrophic scars: a prospective consecutive trial of case series.
Arch Dermatol.
1993;129(9):1146 " 1151. [View Abstract]
18
Zuber TJ.
Office Procedures
. Baltimore: Williams & Wilkins; 1999. 19
2008 MAG Mutual Healthcare Solutions, Inc. 's
Physicians ' Fee and Coding Guide. Duluth, Georgia. MAG Mutual Healthcare Solutions, Inc.
2007.