Coding lipoma from superficial subcutaneous tissue

codedog

True Blue
Messages
958
Location
NEW ORLEANS
Best answers
0
When a lipoma is located in the superficial subcutaneous tissue, is it appropriate to code in the integumentary section or musculosketal section ?:confused:



PREOPERATIVE DIAGNOSIS: Left inguinal adenopathy.

POSTOPERATIVE DIAGNOSIS: Left inguinal masses.

PROCEDURE PERFORMED: Excisional biopsy of left inguinal soft tissue mass x2.

ANESTHESIA: MAC.

ESTIMATED BLOOD LOSS: Minimal.

CLINICAL HISTORY: with persistent left lower extremity edema of uncertain etiology. Patient has developed left inguinal adenopathy and by exam and a biopsy was requested by his hematologist. He has had a workup for DVT, which was negative.

PROCEDURE IN DETAIL: The patient was brought into the operating room and placed on the operating room table in a supine position. The left groin was prepped and draped in sterile fashion. The most dominant mass was between 1-2 cm inferior to his inguinal ligament. After injecting 8 cc of 1% lidocaine with epinephrine, a linear incision was made directly over the mass. Electrocautery was used to dissect through the subcutaneous tissue down to the mass, which grossly appeared consistent with about a 2 cm lipoma. This was completely excised. Hemostasis was achieved with electrocautery. The skin was closed with interrupted 3-0 nylon suture. Because it did not appear that this was a lymph node, biopsy of an additional mass was obtained over the inguinal ligament. A 5 cc of 1% lidocaine with epinephrine was injected for local anesthesia. A linear incision was made directly over a mass about 2 cm superior to this. Electrocautery was used to dissect through the subcutaneous tissue and in the superficial subcutaneous tissue, one of these masses was excised and it was also consistent with lipoma. This was transected; half was sent to culture and half was sent fresh to the pathologist lab. The wound was irrigated with normal saline, inspected, and found to be hemostatic. The skin was closed with interrupted 3-0 nylon suture. The patient tolerated the procedure well.
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
Best answers
0
When a lipoma is located in the superficial subcutaneous tissue, is it appropriate to code in the integumentary section or musculosketal section ?:confused:



PREOPERATIVE DIAGNOSIS: Left inguinal adenopathy.

POSTOPERATIVE DIAGNOSIS: Left inguinal masses.

PROCEDURE PERFORMED: Excisional biopsy of left inguinal soft tissue mass x2.

ANESTHESIA: MAC.

ESTIMATED BLOOD LOSS: Minimal.

CLINICAL HISTORY: with persistent left lower extremity edema of uncertain etiology. Patient has developed left inguinal adenopathy and by exam and a biopsy was requested by his hematologist. He has had a workup for DVT, which was negative.

PROCEDURE IN DETAIL: The patient was brought into the operating room and placed on the operating room table in a supine position. The left groin was prepped and draped in sterile fashion. The most dominant mass was between 1-2 cm inferior to his inguinal ligament. After injecting 8 cc of 1% lidocaine with epinephrine, a linear incision was made directly over the mass. Electrocautery was used to dissect through the subcutaneous tissue down to the mass, which grossly appeared consistent with about a 2 cm lipoma. This was completely excised. Hemostasis was achieved with electrocautery. The skin was closed with interrupted 3-0 nylon suture. Because it did not appear that this was a lymph node, biopsy of an additional mass was obtained over the inguinal ligament. A 5 cc of 1% lidocaine with epinephrine was injected for local anesthesia. A linear incision was made directly over a mass about 2 cm superior to this. Electrocautery was used to dissect through the subcutaneous tissue and in the superficial subcutaneous tissue, one of these masses was excised and it was also consistent with lipoma. This was transected; half was sent to culture and half was sent fresh to the pathologist lab. The wound was irrigated with normal saline, inspected, and found to be hemostatic. The skin was closed with interrupted 3-0 nylon suture. The patient tolerated the procedure well.
That's an excision of a benign lesion (11400-11446, although I think that the groin is limited to 11400-11406, depending on size); I don't see any margins documented, so assuming the total mass excised was 2cm, the first lipoma excision would be 11402.

The second lesion should also be reported with an excision code, based on its description in the note; but since no size of that lesion is documented (as far as I can tell, anyways), you're only able to report a biopsy code, at the moment (11100-59).

I'd ask the provider to make an addendum, noting the size of the second lesion, so it can be reported properly - he'll be losing money on reimbursement, if it has to be reported as a simple biopsy, when it's actually an excision. (Just as a reminder - if you do get the size of the 2nd lesion, you don't report 11100 - it's included in the excision codes...) Hope that made sense!:p
 
Last edited:
Top