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Integumentary System

Posted by medical-coding-resources on May 14, 2009 at 4:43 AM

 

A couple of weeks ago I emailed some of our members and asked if they had any requests for information and they mentioned a HOW TO CODE section would be helpful so here is one

 

Integumentary System – Removal of Lesions

When a physician removes a malignant lesion, do not automatically code from the 11600-11646 section of the CPT book.

 

Carefully review the documentation to see if the physician made a wide excision and if it was necessary to go into soft tissue. Codes from the Musculoskeletal section may more appropriately describe the service and the reimbursement rate is substantially higher. For example, the excision of a tumor of the hand or finger (subcutaneous) may be coded as 26115.

 

The following information is needed to accurately code the removal of lesions:

• whether lesion is malignant or benign,

• site or body part involved with lesion,

• size of the lesion, including margins, in centimeters before it is removed; when more than one dimension for a lesion is provided, select the largest dimension for coding,

• method of removing the lesion, e.g., paring, shaving, debridement,

• type of wound closure/repair: simple, intermediate, complete

• repairs of the same classification and location should be added together and reported as a single item, and

• re-excision of a malignant lesion performed to ensure all of the malignancy has been excised should be coded as an excision of a malignant lesion even if the lesion is no longer present.

 

Assist your coding with this conversion chart

0.24 – 0.39 inch 0.6 – 1.0 cm

0.40 – 0.79         1.1 – 2.0

0.80 – 1.19          2.1 – 3.0

1.20 – 1.57          3.1 – 4.0

>1.57 >                4.0

1.02 – 2.95          2.6 – 7.5

2.99 – 4.93          7.6 – 7.5

4.94 – 7.89          7.6 – 12.5

7.9 – 11.8           12.6 – 20.0

>11.8 >                30

THE INCHES HAVE BEEN ROUNDED FOR CLARITY.

1 INCH = 2.54 CENTIMETERS; 1 CENTIMETER = 0.3937008 INCHES.

 

Measurement of a lesion includes margins. Check the Pathology Report   to ascertain the location of the correct size of the lesion in the medical record before coding. If tissue is excised beyond the margin for repair approximation, it is not counted. The code for excision of a benign or malignant lesion includes simple closure.

 

 

Use more than one procedure code if the same procedure is performed on different anatomical sites with different incisions

 

 

 Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and superficial dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization of the wound. The wound does not require suture closure. See codes 11300-11313.

 

 

 Simple repair refers to suturing of a superficial wound involving skin and/or subcutaneous tissues, without significant involvement of deeper structures. It includes local anesthesia and chemical or electrocauterization of wounds not closed. Do not assign a procedure code for application of Steri-Strips to close a wound.

 

Intermediate repair describes the repair of wounds that require layered closure. Deeper layers of such wounds are usually involved, such as superficial (non-muscle) fascia, so at least one of the layers requires separate closure. Remember that the use of two kinds of sutures do not indicate layered closure. Single-layer closure of contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.

 

Complex repair describes the repair of wounds requiring reconstructive surgery (more than layered closure), complicated wound closure or unusual and time-consuming repair techniques to obtain the best functional and cosmetic result (i.e., scar revisions, debridement of traumatic or avulsed lacerations, extensive undermining or retention sutures). Creation of the defect may be included and any necessary preparation for repair or the debridement and repair of complicated lacerations of avulsions.

 

 Debridement or decontamination of a wound is coded separately only when a wound requires prolonged cleansing, when appreciable amounts of devitalized tissue are removed, or when debridement is a separate procedure without immediate primary closure. In these instances, codes from the 11040-11044 range are assigned. There should be supporting documentation by the physician that will justify the use of the debridement code.

 

 When a wound repair requires that blood vessels, tendons, or nerves be repaired, such repairs are reported under the appropriate system (cardiovascular, musculoskeletal, nervous ) and the skin repair is not coded.

 

 The simple ligation of vessels in an open wound and the simple exploration of exposed nerves, blood vessels or tendons in an open wound are considered part of the repair of the wound and are not separate procedures.

 

 Do not use complex repair codes for 1cm less than or any repairs other than eyelids, nose, ears, and/or lips. Use simple/intermediate repairs.

 

 All wounds repaired in the same classification-simple, intermediate or complex-should be measured and documented in centimeters, whether curved, angular or stellate. (Example: The patient has open wounds of the forehead, 1.5cm, of the chin, 1.0 cm, and of the nose, 0.5cm. The wounds are repaired in a simple closure. Assign CPT code 12013 for the repair of the wounds, as it equals 3.0 cm.)

 

 The principal procedure is the more complicated type of repair when more than one classification of wounds is repaired.

 

For full-thickness repair of lip or eyelid, see the appropriate anatomical section of the CPT book.

 

When frozen section pathology reveals margin excisions that are not adequate, a single excision code should be used to report the additional excision and re-excision(s) necessary at the same operative session. Similarly, re-excision procedures performed to widen margins at subsequent operative sessions should be reported by using the code appropriate to identify the size, location, and type of excision performed. The –58 modifier should be appended if the re-excision is performed during the post-operative period of the primary excision procedure.

 

Let me know if you see any errors I did a quick copy and paste for this

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1 Comment

Reply Peggy
4:18 PM on May 14, 2009 
I just wanted to add that if a closure is done using tissue adhesive (skin glue), it is considered a simple repair. Repair done using adhesive strips (Steri-Strips) is coded using the appropriate E/M code.

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