Labial lipoma

rsboggs

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Description of the procedure is:

Preoperative diagnosis: Right labial lipoma.

Operation performed: Excision of 7-cm lipoma, right labia.

I could not be sure that this did not come in through the inguinal canal so I did a low inguinal incision. The incision was made and carried down to the external ring. I then tracked into the central labial compartment and a large lipoma was identified in this compartment. It was mobilized by pushing on the right labia and everting it into the low inguinal incision. The entire labial lipoma was removed. Once this was done, approximately 7-cm of fat had been removed. it also was removed from the round ligament and vascular structures, which was visible exiting the external ring. There was no evidence of hernia. The subcutaneous was closed with 3-0 Vicryl. The skin was closed with staples.

Question: Would you use 27045 excision of deep tumor pelvis and hip area, or
57135 excision of vaginal tumor? I feel it is 57135, any input would be great!

Thanks!
 

heathermc

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I think I would have to go with unlisted 58999. With code 57135 the Coders Desk Ref. states using a speculum and removing vaginal cyst/tumor. There is not a code for labial cyst removal, so I would use the unlisted.
 

preserene

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Labial lipoma- benign lesion of the genitalia (vulval; labial = vulval). It does not belong to vagina (vagina has mucosa).
It does not merit pelvic code because the internal ring was not opened to expose the pelvic cavity. There was no hernia/herniation.
It neither belongs to bone (pelvis or hip).

I feel it merits assigning to -excision benign lesion of genitalia more than 4 cms- 11426.
Again, since it involves extended excision to the inguinal region and increased work than normal,, can we append mod -22.
The mention about round ligament is justified because the round ligament though predominantly an internal organ as such as a tubular ligament when it emergesdistally and externally out of inguinal ring, it diffuses into fibrous tissues and gets lost at the labia.

Hi some one correct me if I am wrong in assigning the code so.
 

acf7575

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Labial lipoma- benign lesion of the genitalia (vulval; labial = vulval). It does not belong to vagina (vagina has mucosa).
It does not merit pelvic code because the internal ring was not opened to expose the pelvic cavity. There was no hernia/herniation.
It neither belongs to bone (pelvis or hip).

I feel it merits assigning to -excision benign lesion of genitalia more than 4 cms- 11426.
Again, since it involves extended excision to the inguinal region and increased work than normal,, can we append mod -22.
The mention about round ligament is justified because the round ligament though predominantly an internal organ as such as a tubular ligament when it emergesdistally and externally out of inguinal ring, it diffuses into fibrous tissues and gets lost at the labia.

Hi some one correct me if I am wrong in assigning the code so.
Liopoma diagnoses are not valid LCD diagnoses for benign lesion removal codes.
 
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