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Flank mass vs Abdominal wall mass


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Stuck on trying to decide which code to use . Doc dictates flank mass , but booking and a nurse notes says abdominal wall mass. Dictation states it was greater than 10 cm , but also states all way down to external oblique laterally. , so does this qualify for subfascial? booking was 22903 ,but I think its more 29131 or 21933, , what do you think ?


POSTOPERATIVE DIAGNOSIS: Right flank mass, greater than 10 cm, clinically lipoma.

PROCEDURE PERFORMED: Complex closure and placement of drain.



COUNTS: Lap, sponge, and needle counts were all correct.

PROCEDURE IN DETAIL: After appropriate informed consent was signed, the patient was taken to the operating room and was transferred to the operating table and underwent general anesthesia with endotracheal intubation. The patient was placed in a left lateral decubitus position with beanbag. The area has been marked by me in the preoperative holding area and the area was prepped and draped in normal fashion. Antibiotics were given prior to skin incision. Incision was made directly over the mass through the skin, through the subcutaneous tissue. The mass clinically appear to be a lipoma and went all the way down to external oblique laterally. It was grater than 10 cm. The entire area with surrounding capsule was removed with Bovie cauterization, to Pathology for permanent section. Excellent hemostasis was noted to be obtained. There was no evidence of an abdominal wall defect. A 10 French Blake drain was left because of the empty space and the area was then closed with 3-0 Vicryl pop-off staples and 3-0 nylon on the skin and drain sewn with 3-0 nylon. Sterile dressing was placed. The patient tolerated the procedure and was transferred to recovery room in stable condition.


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Being that the patient was laid on their side (lateral decubitus position), location was external oblique, dr dictated flank, and no mention of entering the fascia. For a private payer, I'd code flank 21931 13100 (possibly larger if dr adds addendum with size of repair). CMS will bundle the repair into 21931 and it's impossible to justify 13100-59 as separate and distinct.
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