AN2114

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Auburn Hills, MI
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The doctor removed a forehead mass that went to the skull and complex multilayer closure. The codes I found for forehead mass are 21011-21014 but none of those codes involve the bone. I also looked at code 11420. The doctor is waiting for the pathology report but he believes it might be a dermoid cyst. I'm not sure if I should use the codes I mentioned and add modifier 22 since he excised down to the skull or if anyone knows a better code.

Here is the op report:

Postoperative diagnosis: Midline congenital forehead mass

Procedure: Excision of deep congenital midline forehead mass with track to skull and complex multilayer closure.

Findings: 3cm multilobular midline forehead mass extending to the skull and causing a divot in the bone.

Details:

Patient was taken to surgery induced with general anesthesia and intubated. The mass was identified and the surrounding skin was infiltrated with 4cc of 1% Xylocaine with epinephrine 1:100,000. The area was sterilely prepped and draped. An elliptical 2cm horizontal incision was made over the punctum that was overlying the mass. The mass was identified to be consistent with multilobular cystic midline mass extending all the way to the bone. This was dissected sharply away from it's surrounding attachments with care to not violate the capsule through skin subcutaneous fat, muscles and down through periosteum. The mass extended all the way to the frontal bone. There was divot in the bone where the mass orginated. The mass was excised and dissociated directly from the bone with careful dissection. The stalk was tied off and passed off to be sent for pathology. The mass was 3.5 cm. The wound was irrigated with sterile water and bleeding was controlled with bipolar cautery and bovie. The deep dermal and muscular layers were closed with 3-0 vicryl suture, and the skin was reapproximated with 5-0 monocryl in a subcuticular. The incision was dressed with mastisol and steri-strips. A pressure dressing was applied. Patient was returned to the care of the anesthesia team and then transferred to PACU in a stable condition.
 
I would wait for the pathology to come back to see if this was malignant or benign as that could change your coding, just so the provider gets the full reimbursement of the procedure. Also, where did it originate? From the documentation, it originated in the cutaneous origin which may lead your coding to the 11420-11426 or 11620-11646.

It doesn't look like he cut into the bone he just excised "to the bone". There was a divot in the bone from the tumor.

Hope this helps you in your coding for this procedure.
 
I would wait for the pathology to come back to see if this was malignant or benign as that could change your coding, just so the provider gets the full reimbursement of the procedure. Also, where did it originate? From the documentation, it originated in the cutaneous origin which may lead your coding to the 11420-11426 or 11620-11646.

It doesn't look like he cut into the bone he just excised "to the bone". There was a divot in the bone from the tumor.

Hope this helps you in your coding for this procedure.
Thank you!!
 
I would not use the skin excision codes. It sounds like the excision was much deeper and this is much more than a skin excision. I would wait for the pathology for both the diagnosis and to see if the bone is included in the path report.

Then, depending on the morphology of the lesion, I would code 21013 or 21014, excision soft tissue subfascial (that is pretty deep) depending on the size if the lesion is benign. If the lesion is malignant, I would code 21015 or 21016 depending on the size.
 
I would not use the skin excision codes. It sounds like the excision was much deeper and this is much more than a skin excision. I would wait for the pathology for both the diagnosis and to see if the bone is included in the path report.

Then, depending on the morphology of the lesion, I would code 21013 or 21014, excision soft tissue subfascial (that is pretty deep) depending on the size if the lesion is benign. If the lesion is malignant, I would code 21015 or 21016 depending on the size.
Thank you!
 
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