Can anyone review this and tell me what codes you get? The physician wants to use 11200 for procedure 1 and 11440 for procedure 2. The path report shows fibroepithelial polyp for both of these procedures. I would just like to see what others get for these.
PREOP DIAGNOSIS:1. lesion on left upper lid lateral- skin tag
2. left eyelid margin lesion mid lid
POSTOP DIAGNOSIS: 1.lesion on left upper lid lateral- skin tag
2. left eyelid edge lesion mid lid
PROCEDURE:1. Removal of skin tag left upper lid
2. excisional biopsy of left upper lid edge lesion with closure.
ANESTHESIA: Injection with 1%Xylocaine 1:100,000 epinephrine
INdications; Presen greater than 6 months, 2 Separate lesions, left upper lid skin tag which was prominent and irritative to pt causing discomfort on opening and closing of the lid. Pt desired to have it removed. Additionally pt has noticed a lesion on the left eye upper lid edge that has increased over several months bothersome to pt, some times in the sitting position it tends prolapse over the edge. It is elevated, lobulated, skin colored. It is not on a pedicle.s
DESCRIPTION OF PROCEDURE: Pt was brought to the procedure room, laid in a semi lounge chair position and prepped and draped in the usual manner. Once good local anesthesia was applied. the upper lid skin tag was in the lateral aspect of the lid , midway between the brow and lid edge. Pt additionally has blepharochalasia. The skin tag was lifted and trimmed at its base, a small prominence still persisted thus the castroviejo scissors were used to trim it. The loose skin tended to drape together easily without tension. Dermabond was applied with a fine probe dipped in Dermabond and applied
Next the eyelid margin lesion was addressed. The gross lesion was measured, markings around it were made. A knife was used to excise the gross lesion of the lid margin lesion which approximated the lid edge within a 1-2 mm. The lesion was skin color ,elevated and lobulated. And tended to hang over the margin in a sitting position. .The lesion was excised using the knife blade 11 and a castroviejo scissors.
it was a 2x3 mm lesion. The skin edges were approximated and dermabond was carefully applied with a small probe instrument .
Findings : lesion skin tag upper lid away from margin edge
upper eyelid edge (mid)lesion lobulated, elevated 2x3 excised and reapproximated
PREOP DIAGNOSIS:1. lesion on left upper lid lateral- skin tag
2. left eyelid margin lesion mid lid
POSTOP DIAGNOSIS: 1.lesion on left upper lid lateral- skin tag
2. left eyelid edge lesion mid lid
PROCEDURE:1. Removal of skin tag left upper lid
2. excisional biopsy of left upper lid edge lesion with closure.
ANESTHESIA: Injection with 1%Xylocaine 1:100,000 epinephrine
INdications; Presen greater than 6 months, 2 Separate lesions, left upper lid skin tag which was prominent and irritative to pt causing discomfort on opening and closing of the lid. Pt desired to have it removed. Additionally pt has noticed a lesion on the left eye upper lid edge that has increased over several months bothersome to pt, some times in the sitting position it tends prolapse over the edge. It is elevated, lobulated, skin colored. It is not on a pedicle.s
DESCRIPTION OF PROCEDURE: Pt was brought to the procedure room, laid in a semi lounge chair position and prepped and draped in the usual manner. Once good local anesthesia was applied. the upper lid skin tag was in the lateral aspect of the lid , midway between the brow and lid edge. Pt additionally has blepharochalasia. The skin tag was lifted and trimmed at its base, a small prominence still persisted thus the castroviejo scissors were used to trim it. The loose skin tended to drape together easily without tension. Dermabond was applied with a fine probe dipped in Dermabond and applied
Next the eyelid margin lesion was addressed. The gross lesion was measured, markings around it were made. A knife was used to excise the gross lesion of the lid margin lesion which approximated the lid edge within a 1-2 mm. The lesion was skin color ,elevated and lobulated. And tended to hang over the margin in a sitting position. .The lesion was excised using the knife blade 11 and a castroviejo scissors.
it was a 2x3 mm lesion. The skin edges were approximated and dermabond was carefully applied with a small probe instrument .
Findings : lesion skin tag upper lid away from margin edge
upper eyelid edge (mid)lesion lobulated, elevated 2x3 excised and reapproximated