Using 30195

Hi all

 

I am starting a new thread about 30195 because I think it is a slightly different topic, started below by a post from Dr Dai Tran, I think. Please sign your name and use punctuation. I think I have used 30195 maybe 10 times in the last year.

 

“benign neoplasms are abnormal growth of cells without evidence of malignancy. 30195 is intended for removing lesions that may potentially become malignant such as actinic keratosis that may not be suitable for freezing ( ie hypertrophic AK – here you want to sent the stuff away for pathology !! ) . other neoplasms of significance include PYOGENIC granuloma, here you want to 30195 to aid healing and for pathology.  Intradermal naevus hanging off you face that is interfering with your vision, here you can 30195…… NOW, HONESTLY can someone do a 30195 on every Joe Blow that walks in to your office ?? YOU have got to be kidding yourself if you 30195 every 2nd or 3rd person … this either mean you don’t know what you are doing or that you are short of cash and don’t give a stuff about other people who want to use 30195 for legit reason”

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  1. #1 by Andrew Montanari on February 12, 2011 - 5:55 am

    Dr Katz,
    Did you only use 30195 ten times last year, because you’re a pathologist and don’t see as many patients as a clinician?

    I use 30195 for a couple of things:
    1. Shave removal of protruding, benign naevi that recurrently catch on clothing, get inflamed and are painful. Usually along belt line, around collar or under bra straps. (if at all suspicious, send to histo).
    I would see a couple a week at least. They always tell me that no one would remove them.

    2. Curettage (under LA or freeze) or hyfrecator removal of thick solar keratoses that you know will not repsond to liquid N2. [You could use deeper cryo for these thick lesions but the site will take much longer to heal and the hypopigmentation/scar will not impress the patient.]

    2a. Also for solar keratoses that the patient says did not quite go after recent cryo. As you suggested, I tend to treat these by shave removal and send for histo to exclude SCC.

    3. Other symptomatic hamartomas – eg neurofibromas(tuncal), papillomas(scalp- catch on comb), Campell de Morgan angiomas(when large and keep getting knocked. Suprisingly they don’t bleed much and patients are very grateful]. I would see one or two a month.

    On the other hand, I know it would be easy to curette every second person with a slightly thick AK, but 10 a year is equally not reflective of what I would feel to be reasonable.

    Comments suggesting 10 a year to be a fair level, only gives the bureauclowns more ammo.

  2. #2 by Dr Ian Katz on February 12, 2011 - 7:05 am

    Hi Andrew – call me Ian
    As you know, with skin cancer medicine there are numerous ways to manage most things, dependent on doctor (how you were taught, time available etc), patient factors and situational factors.

    I tend to use 30071 for most of the things that you have mentioned as I send most to histo and you can use it mutiple times at a single visit. My problem with 30195 for protruding things is that occasionally they are polypoid sebK or FEP’s and then the billing is inappropriate.

  3. #3 by Alan Cameron on February 13, 2011 - 4:26 am

    “In my view” the correct item number comes down to your intent in performing the procedure.
    eg for a naevus, did you shave a macular naevus to exclude melanoma (30071) or to ablate a benign polypoid naevus to stop it catching on the patient’s shirt collar (30195). In the first instance there is but not therapeutic intent, and vice versa for the second.
    A solar keratosis is less clearcut. In my practice I would virtually always be submitting solar k where there is a need to exclude SCC. I think if you shave the lesion and stop at that, this is 30071, but I think if you have proceeded with curettage and cautery after the shave, then the therapeutic intent makes this 30195.
    What’s an appropriate number to bill? Depends on your practice. I do LOTS of shaves, both diagnostically and therapeutically, and also use C&C extensively. So I do use 30195 more than 10/yr. Others who do more punch biopsies and formal excision and suture will have less occasion

  4. #4 by Dr Ian Katz on February 13, 2011 - 4:39 am

    but what happens if you use 30195 for a polypoid naevus and it comes back as a skin tag from histo. Do you wait for histo before billing 30195?
    Surely you dont chuck polypoid naevi away without histo?

  5. #5 by Stewart Precians on February 13, 2011 - 10:40 am

    I agree that shave excision for benign nodular naevi gives an excellent result and is so easy for patient and doctor; have lots of patients who have been amazed how well a shaved facial dermal naevus went, they had been told for years by their GP that the excision “scar may be worse than the mole”.

    Have to agree with Ian about the inappropriateness of doing a 30195 every second patient.

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