21555 vs 114xx?

BFAITHFUL

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I need help with the following: I don't think it's clear on the location (depth) of the mass which according to the path. report it's a lipoma, if it's located in the skin then i know it's an integemuntary code, if mass is located in the subq tissue then i know to go with the musculoskeletal codes and there's no size!

DX: neck mass
Path results: Lipoma

We used a 15 blade scalpel and created a transverse incision across the neck and then carried this down by electrocautery circumferentially around the mass, which was then excised and blocked. This was then sent off for permanent section. We then irrigated the area making sure hemostasis was controlled with bovie electrocautery. Once hemostasis was controlled, we used 0-Vicryl to approximate the subcutaneous tissues. We then used 4-0 Monocryl to approximate the skin edges. We then cleansed and dried the skin and placed derrmabond.
 
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Hi,

I don't think there is any confusion at all. First, it is a lipoma, which occurs in adipose tissues, thereby musculoskeletal code. Secondly, it is a transverse incision, generally an elliptical incision is made for skin procedures. You can go ahead with 21555.

-
 

BFAITHFUL

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My confusion came when one of our auditors showed me an article from the American Academy of Dermatology stating that lipomas can also be found in the skin, so therefore when coding excision of lipomas, one must be careful and find out the dept of lipoma because if it was found in the skin the coder is use the integumentary codes 114xx but if found in the soft tissue such as in the subcutaneous tissue then code using the musculoskeletal codes.

thank you
 

BFAITHFUL

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sorry... one more thing..

Per AMA CPT Assistant
According to CPT® Assistant August 2006 if a lipoma is excised from a superficial location it would be appropriate to use excision codes from the integumentary system (e.g. 11400-etc). If the lipoma is in deep subcutaneous, subfascial or submuscular tissue use code from musculoskeletal system (e.g. 21930).

As far as the transverse incision...this type of incision can also be done for even dermal lesions .. See below:
Shaving of Epidermal or Dermal Lesions
Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization. The wound does not require suture closure.

AND

even if you look at the Medicare, their local coverage guidelines state the following which shows that the integumentary codes can also be used for lipomas:

"However, in selected circumstances, the removal of lesions (e.g., seborrheic keratoses, epidermoid cysts, moles (nevi), acquired hyperkeratosis, molluscum contagiosum, milia, viral warts, benign neoplasms, hemangiomas, lipomas[/I], and pyogenic granulomas) is medically appropriate. Therefore, Medicare will consider their removal as medically necessary, and not cosmetic, if one or more of the following conditions are present and clearly documented in the medical record" The follow CPT codes is listed for this:

11300 - 11313
11400 - 11446
11200 - 11201
11100 - 11101
 
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