Wiki Feedback request-Excision of hemangioma/benign lesion with extensive undermining

[whitefield13]

Hi,
Posting again for some feedback.
Report:
1.Excision of a 2.5 cm hemangioma on the waistline with extensive undermining and closure.
2.Excision of benign 1.5 cm lesion of the left ankle with extensive undermining and closure.

OPERATION IN DETAIL: After sterile preparation and draping in the normal sterile fashion and local anesthetic, the lesions were approached. The ankle lesion was elliptically excised. Extensive undermining was required in order to close the large defect caused, since the halos of the lesion also required excision.

After extensive undermining, the deepest layer was closed with 3-0 PDS, the more intermediate layer was closed with 4-0 PDS, and the most superficial layer was closed with 5-0 PDS suture, followed by treatment with Dermabond and Steri-Strip placement.

Next, attention was then turned to the hemangioma on the waistline. This was not only completely excised, but it was also cauterized in order to prevent bleeding afterwards, and it was also closed using the deep 3-0 PDS suture, followed by the 4-0 PDS suture, and finally followed by the 5-0 PDS suture. Dermabond and Steri-Strips were also placed on this.
Answer: I have 86.3 and 86.89 for the ICD-9 procedure code and CPT codes 11403,11402-51, 13100-51, 13120-51. ICD-9 CM diagnostic codes 228.01 and 709.9 . Am I right on these?
Any feedback is appreciated.
Thanks!

 

[mjewett]

I think I would code from musculo instead of integumentary on those, but op note is a little lacking to be sure. If the incision is made down to sub-cu or deeper codes 22902 or 27618 may apply.

 

[whitefield13]

Full report -Excision of hemangioma/ benign skin lesion

Hi,
Thanks for the reply. I appreciate the feedback! I think the integumentary approach may still be the right one. I am providing the full operative report below.

Operative Report

INDICATIONS: The patient is seen for excision of skin lesions of the left ankle and a hemangioma of the waistline with recent changes including size, color/pigment, and chronic irritation with bleeding.

PROCEDURES:

Excision of a 2.5 cm hemangioma on the waistline with extensive undermining and closure.
Excision of benign 1.5 cm lesion of the left ankle with extensive undermining and closure.
OPERATION IN DETAIL: After sterile preparation and draping in the normal sterile fashion and local anesthetic, the lesions were approached. The ankle lesion was elliptically excised. Extensive undermining was required in order to close the large defect caused, since the halos of the lesion also required excision.

After extensive undermining, the deepest layer was closed with 3-0 PDS, the more intermediate layer was closed with 4-0 PDS, and the most superficial layer was closed with 5-0 PDS suture, followed by treatment with Dermabond and Steri-Strip placement.

Next, attention was then turned to the hemangioma on the waistline. This was not only completely excised, but it was also cauterized in order to prevent bleeding afterwards, and it was also closed using the deep 3-0 PDS suture, followed by the 4-0 PDS suture, and finally followed by the 5-0 PDS suture. Dermabond and Steri-Strips were also placed on this.

The patient tolerated the procedure well. No complications occurred throughout. Due to the lesions being fairly complex in nature, compared to the average skin lesions, the patient was placed on antibiotics post procedure. She will follow up sometime in the next few weeks for re-evaluation, sooner if she has any problems.
My impression: 86.3 and 86.89 for the ICD-9 procedure code. CPT codes 11403,11402-51, 13100-51, 13120-51. ICD-9 CM diagnostic codes 228.01 and 709.9. Let me know what you think. Any feedback is appreciated!
Thank you!