Wiki Derma Codes Help

[Ravikirann]

Hi All,

Whether i coded correctly or not from the below OT notes.

FINDINGS:
1. It is a 1 cm right upper arm lesion, a). A 3 cm x 1 cm excision.
2. 1.2 cm left supraclavicular lesion a). A 4 cm x 1.5 cm excision.
3. Multiple skin tag excisions, left axilla and right neck.
4. A left leg skin neoplasm measuring 4 x 5 cm.

BRIEF HISTORY: The patient is a 53-year-old gentleman with a history of basal cell carcinoma as well as melanoma, who presents with atypical skin lesion. Excision was recommended and consent was obtained. He was prepared for the minor room operative procedure.

DESCRIPTION OF THE PROCEDURE: After proper identification in holding, the lesions were confirmed with the patient and he was taken to the operating room and placed in a supine position. His right upper arm was prepped and draped in a sterile fashion. Local lidocaine and Marcaine was instilled around the atypical lesion and this was excised with good margins. Hemostasis was excellent and controlled by electrocautery and two-layered closure was performed with interrupted Vicryl and interrupted running nylon. Dry dressing was applied. I then turned my attention towards the left supraclavicular lesion. A fresh blade was utilized for excision after instilling local lidocaine and marcaine. This was excised down to fat and electrocautery was utilized to create hemostasis. Skin was extensively undermined and then two-layered closure was performed with interrupted Vicryl and interrupted running nylon. Dry dressing was applied. He had multiple skin tags in left axilla and right neck. These were excised and desiccated without difficulty. Attention was directed to the left leg. An elliptical incision was made around the lesion and it was excised with no difficulty. Closure seems to be necessary with advancement flap due to the size of excision. Bilateral flaps were advanced and rotated into position covering the excisional defect. Skin was closed with interrupted Vicryl suture. He tolerated the procedure well. Needle and sponge counts were correct and he is transferred to recovery in stable condition.


The Codes are -
11042-59
11045
26440
14021

Thanks

 

[alkavkapoor]

As per documentation, this is not debridement but excision of skin lesion and ATT for the lower leg lesion.We need to confirm if lesion was benign or malignant though. for Benign lesions see below

The codes are as below:
11404 - skin lesion on left arm
11403-59 - skin lesion on right arm
14021 - for ATT leg

for skin tag removal we need to know the number of tags removed as the codes are based on number of lesions for eg 11200.

I cant see any documentation for 26440.

Hope this helps.

 

[CodingKing]

In addition to it being excision and not debridement i see an intermediate and complex closure in there for the arm lesions which is separately billed from the excision codes (only simple is bundled). I'm assuming only the phrase extensive undermining is enough vs explaining how involved is required for complex. Both were layered closure so at least intermediate.

Skin tags since the actual number is not listed can only go with the lowest 1-15 tag code.

 

[Ravikirann]

Very Good Learning Chance For Me

Hi,

Thanks for your valuable feedback's. The cpt's 11042 is a typo error instead of 11402.But still i would have coded wrongly. 26440 is coded from no where .
both intermediate and complex repair are performed on different site so i will code both repair code. Thanks for alerting me.


Thank you very much Guy's.