Determine the most accurate diagnosis codes and procedures codes along with any modifiers, if appropriate.
Determine the most accurate diagnosis codes and procedures codes along with any modifiers, if appropriate.
PATIENT: NEWCOMB, CLIFFORD ACCOUNT/EHR #: NEWCCL001 DATE: 10/15/18 This new patient is a 41-year-old male who presents with a 6-month history of a slowly growing, firm, welldefined, exophytic, and asymptomatic nodule measuring 1.2 cm in diameter. The lesion is on the proximal plantar surface. HISTORY: Approximately 3 months prior to this encounter, the patient self-treated the lesion (which he thought was a wart) for 2 weeks with a topical salicylic acid 17% liquid. There was no response. TESTING: An incisional biopsy and a saucerization biopsy is done. The histologic evaluation confirms eccrine poroma. PLAN: Surgical excision, with clear pathologic margins, is discussed and recommended to the patient. DX: Eccrine poroma Patient states he wants to discuss the surgical option with his wife. He says he will call our office within 72 hours to schedule surgery. Scott Cole, DPM
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