27630 vs 27618

codedog

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doc office wants to bill 27630- excision of lesion of tendon sheath or capsule, I SAY ITS 27618 because of of excision of soft t tissue- now no record of size but cpt code says 3cm or small er- who is right ?, path report came back as a lipoma

POSTOPERATIVE DIAGNOSIS: Right ankle mass.
OPERATION: Excision of right ankle mass.

HISTORY: The patientwith a history of enlarging mass in the lateral aspect of r right ankle. was evaluated and worked up with an MRI, and found to have a lipomatous-type mass. It was interfering with shoe wear, was uncomfortable, and elected to go forward with excision.
PROCEDURE IN DETAIL:
After appropriate informed consent was obtained, the patient was brought to the operating room and placed on the operating table. General anesthesia was induced. The right ankle and leg were prepped and draped in a sterile fashion. After it was exsanguinated and the tourniquet inflated to 250 mmHg. An oblique incision was carried out at the lateral aspect of the ankle anterior to the fibula over the soft tissue mass. Dissection was taken down to the skin where a mostly encapsulated lipomatous-type mass was encountered. It was dissected free with blunt and sharp dissection. Care was taken to protect the subcutaneous nerve branches. Following excision of the mass, it was sent for specimen. Hemostasis was obtained with electrocautery. It was then thoroughly irrigated. The tourniquet was deflated. Hemostasis was again obtained with electrocautery then irrigated again and closed with 3-0 Vicryl and 3-0 nylon. was placed in a sterile dressing and brought to Recovery in stable condition. thanks
 

jdemar

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I would have to agree with you, the op notes states 'dissection was carried down to the skin', (do they mean subcutaneous? how deep? not very clear. It says nothing about the 'tendon shealth or capsule. I would query the Dr.
 
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