Rpollock623
Contributor
I was inquiring on the rational of a study guide question as I am preparing for my CPC test.
per the study the guide the answer to the following question is 12032, 11403-51, 11403-51
Op Note: The pt has an excision of a painful cyst on midline upper back. The lesion has previously ruptured and has significant scarring. The pt also has a painful cyst on the left upper back. The patient is allergic to penicillin and takes asprin and Micardis for blood pressure. Informed consent was obtained from the pt. Risk of the procedure, including bleeding, infection, scarring and recurrence, were explained, and the pt acknowledged understanding of these potential complications.
procedure #1: Excision cyst midline back
The per-op measurement of the lesion was 1.1 cm. The proposed excision line were drawn. Anesthesia was delivered locally with 5.0 cc of 1% Xylocaine with epinephrine buffered 1:10. The site was cleansed with Betadine. The site was prepped and draped in the usual sterile fashion. An incision was performed with a number 15 blade extending deep, through the dermis and into subcutaneous fat. This tissue was dissected from the pt with care to preserve histologic features. The cyst was not enucleated intact, but the contents and cyst wall remnants were extracted. The specimen was placed in a bottle of Formalin, labeled with the pt's identifying information. The specimen was sent for pathologic and/or margin analysis. The surgical site was undermined to a distance of 1.5 cm. Hemostasis was obtained by electrocautery and vessels ligated as necessary. In order to prevent dehiscence due to wound tension, an intermediate layer closure was performed. Three 4-0 Vicryl sutures were placed subcuticularly utilizing a simple inverted interrupted stitch. Four 4-0 nylon sutures were placed cutaneously utilizing a simple interrupted stitch. The final length of the surgical repair was 2.5 cm. The surgical site was cleansed with saline. A sterile dressing was applied utilizing the following: sterile petrolatum, gauze, and tape into place to form a pressure bandage. The patient tolerated the procedure well.
Procedure #2: Excision Cyst Left Upper Back
The preoperative measurement of the lesion was 1.5 cm. The proposed excision lines were drawn. Anesthesia was delivered locally with 6.0 of 1% Xylocaine with epinephrine buffered 1:10. The site was cleansed with Betadine. The site was prepped and draped in the usual sterile fashion. An incision was performed with a number 15 blade extending deep, through the dermis and into the subcutaneous fat. This tissue was dissected from the pt with care to preserve histologic features. The cyst was enucleated in tact via sharp and blunt dissection. The specimen was placed in a bottle of Formalin, labeled with the pt's identifying information. the specimen was sent for pathologic and/or margin analysis. The surgical site was undemined to a distance of 1.0 cm. Hemostasis was obtained by electrocautery and vessels ligated as necessary. In order to prevent dehiscence due to wound tension, an intermediate layer closure was performed. Three 4-0 Vicryl sutures were placed subcuticularly utilizing a simple inverted interrupted stitch. Four 4-0 nylon sutures were placed cutaneously utilizing a simple interrupted stitch. The final length of the surgical repair was 2.9 cm. The surgical site was cleansed with saline. A sterile dressing was applied utilizing the following: sterile petrolatum, gauze, and tape into place to form a pressure bandage. The patient tolerated the procedure well.
I did take this question to my employer who is a certified CPC and CPC-H. Our office feels this coding should be 11406, 12032. Can you clarify and/or rationalize why the coding study guide would code this note as 12032, 11403-51, 11403-51. Thank you in advance for your help.
per the study the guide the answer to the following question is 12032, 11403-51, 11403-51
Op Note: The pt has an excision of a painful cyst on midline upper back. The lesion has previously ruptured and has significant scarring. The pt also has a painful cyst on the left upper back. The patient is allergic to penicillin and takes asprin and Micardis for blood pressure. Informed consent was obtained from the pt. Risk of the procedure, including bleeding, infection, scarring and recurrence, were explained, and the pt acknowledged understanding of these potential complications.
procedure #1: Excision cyst midline back
The per-op measurement of the lesion was 1.1 cm. The proposed excision line were drawn. Anesthesia was delivered locally with 5.0 cc of 1% Xylocaine with epinephrine buffered 1:10. The site was cleansed with Betadine. The site was prepped and draped in the usual sterile fashion. An incision was performed with a number 15 blade extending deep, through the dermis and into subcutaneous fat. This tissue was dissected from the pt with care to preserve histologic features. The cyst was not enucleated intact, but the contents and cyst wall remnants were extracted. The specimen was placed in a bottle of Formalin, labeled with the pt's identifying information. The specimen was sent for pathologic and/or margin analysis. The surgical site was undermined to a distance of 1.5 cm. Hemostasis was obtained by electrocautery and vessels ligated as necessary. In order to prevent dehiscence due to wound tension, an intermediate layer closure was performed. Three 4-0 Vicryl sutures were placed subcuticularly utilizing a simple inverted interrupted stitch. Four 4-0 nylon sutures were placed cutaneously utilizing a simple interrupted stitch. The final length of the surgical repair was 2.5 cm. The surgical site was cleansed with saline. A sterile dressing was applied utilizing the following: sterile petrolatum, gauze, and tape into place to form a pressure bandage. The patient tolerated the procedure well.
Procedure #2: Excision Cyst Left Upper Back
The preoperative measurement of the lesion was 1.5 cm. The proposed excision lines were drawn. Anesthesia was delivered locally with 6.0 of 1% Xylocaine with epinephrine buffered 1:10. The site was cleansed with Betadine. The site was prepped and draped in the usual sterile fashion. An incision was performed with a number 15 blade extending deep, through the dermis and into the subcutaneous fat. This tissue was dissected from the pt with care to preserve histologic features. The cyst was enucleated in tact via sharp and blunt dissection. The specimen was placed in a bottle of Formalin, labeled with the pt's identifying information. the specimen was sent for pathologic and/or margin analysis. The surgical site was undemined to a distance of 1.0 cm. Hemostasis was obtained by electrocautery and vessels ligated as necessary. In order to prevent dehiscence due to wound tension, an intermediate layer closure was performed. Three 4-0 Vicryl sutures were placed subcuticularly utilizing a simple inverted interrupted stitch. Four 4-0 nylon sutures were placed cutaneously utilizing a simple interrupted stitch. The final length of the surgical repair was 2.9 cm. The surgical site was cleansed with saline. A sterile dressing was applied utilizing the following: sterile petrolatum, gauze, and tape into place to form a pressure bandage. The patient tolerated the procedure well.
I did take this question to my employer who is a certified CPC and CPC-H. Our office feels this coding should be 11406, 12032. Can you clarify and/or rationalize why the coding study guide would code this note as 12032, 11403-51, 11403-51. Thank you in advance for your help.
