Wiki Help needed w/skin lesion removal (49 lesions) - Patient was brought

codegirl0422

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would it be 11420 x 48 11421 x1 or 11057 mod 22

Patient was brought to the operating room and placed on the operating room table in the supine position
with IV intact for IV sedation. He was anesthetized utilizing 10 mL of 0.25% Marcaine with epinephrine
injected directly below each skin lesion on the heel on the right foot and a 50/50 mixture of 0.25%
Marcaine and 1% Xylocaine plain in the form of a digital block of the great toe, left side, 4 mL total
volume used on that side. Both feet were prepped and draped in the usual aseptic manner. Attention was
then directed to the heel, right side, where there was a cluster of about 49 skin lesions. We were able to
remove these lesions. All of them were within the dermal layers of the skin. We used a combination of a
64 blade, a curette, and a 15 blade to remove the skin lesions individually. The skin lesions wereclumped and sent to pathology. None of the warts were greater than 0.5 cm in diameter, except for 1
lesion that was on the posterior heel which measured just 0.75 cm in diameter. Each skin lesion was
curetted aggressively at the dermal basement membrane. It was treated with Bovie to cauterize the base,
then re-curettaged and packed with Gelfoam. A significant amount of time was dedicated to removing
all of these skin lesions and they were flushed copiously with normal saline, packed with Gelfoam, and
dry sterile dressings were then applied. Attention was then directed to the left great toe where a digital
tourniquet was applied to the base of the great toe and a skin-plasty was performed, removing a segment
of the hypertrophied nail labia, along with the nail bed and about 1/4 of the medial portion of the great
toenail and toenail matrix. This was a full, wide Winograd type of excision and skin-plasty of the nail
fold. It was taken straight to the periosteum where the periosteum was elevated medial and the area was
flushed with copious amounts of normal saline. Deep curettage of the nail groove was performed. It was
closed with a combination of 3-0 and 4-0 nylon suture. Betadine-soaked Adaptic, Betadine-soaked
gauze, and a dry sterile compressive dressing were applied to the foot and ankle.
 
I see "lesions" in your question, but after reading the report, actually warts were curetted, not "benign lesions", so your code range is 17110...
 
I can't help you today, though, we have almost the same procedure coming up this month. I am watching how other coders will direct you.
 
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