Bought an area of study practice exam and answer does not jive


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I bought the Integumentary area of study practice exam and this question does not make sense with aapc answer.:confused: I have shown it to my instructor and they do not agree with aapc answer either. Would you let me know your thoughts on this. I am taking my exam in 2 weeks, need to know how to code this. Thank you, Debbie:)

Question: A 0.8 cm cystic lesion in the left posterior neck was excised to the level of subcutaneous tissue. Wound closure was accomplished with layers by a series of 4-0 PDS subcutaneous sutures and 4-0 PDS to the superficial dermal layer and then Dermabond. What code(s) should be reported for this procedure?
A. 11421
B. 12041, 11421-51
C. 21555
D. 12041, 11621-51

Rationale: This is a cystic lesion; therefore, it is a benign lesion. The notes under Excision- Benign Lesions indicate benign lesions of the skin. In this case the lesion was excised to the level of the subcutaneous tissue, which is not considered a layer of the skin. The musculoskeletal section includes 21555, which specifically refers to subcutaneous tissue. The notes at the beginning of the section state that 21555 includes simple and intermediate repair. The other codes listed involve excision of the skin which does not include the subcutaneous tissues.
21555 would be correct. You have to code to the furthest extent, and since they went to the subcutaneous, you have to code to the subcutaneous.
A skin excision goes thru the dermal layer and down to or includes the subq tissue. The difference is the abnormality was on the skin so it is a skin excision. If the cyst had been dermal or subq then you would use the 21555.
So I say the correct choice is B. What does the AAPC say?
Yes, I agree and so do my instructors as well as a couple of friends who have been derm coding for years. That the answer is B. But AAPC said it is 21555.

AAPC said - The reason why is due to the depth of the excision that was performed to remove the lesion. Because the excision of the lesion went to the subcutaneous layer, you do not report an Excision - Benign Lesion code (11421). The CPT subsection guidelines for Excision-Benign Lesions, above code 11400 (page 70 in the 2015 CPT codebook), indicates that these codes (11400-11446) are for excision of a benign lesion of the skin, that goes to the dermis. So, if the question said this: A 0.8 cm cystic lesion in the left posterior neck was excised to the level of the dermis tissue; Then you can report code 11421.

In this case the question indicates the removal of the lesion did not go just to the skin (or dermis) it went further down to the subcutaneous level, in that case you can report a code from the musculoskeletal series of codes. Eventhough the code description does say tumor it does not mean that documentation has to say "tumor" to report the code. Terms such as lump, lesion, mass, or lipoma can be used to report code 21555.

The point of the question is to make sure that one understands when to report an integumentary code vs musculoskeletal code when it comes to removing a lesion and the depth of the removal.

This is really tricking and worded really weird. And because I had paid for the practice exam integumentary questions only - I thought it made sense that it would be an integumentary question. Anyway, my instructors, friends, and myself would have gotten this wrong if it was on the exam. :(

Thanks for your help!!!:eek::)
The correct answer would be 21555. It was excised down to the subcutaneous tissue, and the other codes B & D are for repairs. This is not a repair so multiple choice "B" would not be the correct answer.
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