Wiki Unlisted Codes x2 examples

[BS&SC]

Sample 1:
Immediately following a repeat elective c-section, the patient, with a history of myomectomy, had a subcutaneous inclusion cyst excised and a keloid scar excised. I have Z98.890 and O34.219 to work with for Dx. I am thinking 11400 (dependent on diameter with margins) for the keloid scar excision, but can/should I bill something different for the subQ inclusion cyst? I looked at the 58662 but it didn't seem quite right. I looked at 10061, which seems better, but I lack confidence in my reasoning. Obvs, the global c-section would also be coded, so:
59510
Keloid scar excision 11400 (doc hasn't given diameter yet)
SubQ inclusion cyst 10061 or an unlisted code?

Sample 2:
In a separate scenario, provider documented a perforated IUD that was found via US to be in the right adnexa. He coded diagnostic lap, 49329, which I know is not correct. I think this might be the unlisted code, 58999, compared to the 56881 for time, work and procedure, since the IUD was removed from the adnexa. Is there any other code I should be considering?

To anyone who answers, thank you. I most appreciate learning how to think about these things through.

 

[nielynco]

Sample 1:
Immediately following a repeat elective c-section, the patient, with a history of myomectomy, had a subcutaneous inclusion cyst excised and a keloid scar excised. I have Z98.890 and O34.219 to work with for Dx. I am thinking 11400 (dependent on diameter with margins) for the keloid scar excision, but can/should I bill something different for the subQ inclusion cyst? I looked at the 58662 but it didn't seem quite right. I looked at 10061, which seems better, but I lack confidence in my reasoning. Obvs, the global c-section would also be coded, so:
59510
Keloid scar excision 11400 (doc hasn't given diameter yet)
SubQ inclusion cyst 10061 or an unlisted code?

Sample 2:
In a separate scenario, provider documented a perforated IUD that was found via US to be in the right adnexa. He coded diagnostic lap, 49329, which I know is not correct. I think this might be the unlisted code, 58999, compared to the 56881 for time, work and procedure, since the IUD was removed from the adnexa. Is there any other code I should be considering?

To anyone who answers, thank you. I most appreciate learning how to think about these things through.

I would need to see the exact description of work in the op note to assist with this. But on the surface, 10061 is for a complicated I&D which does not seem to be appropriate for a subQ cyst but 11400 could work for the keloid removal. But here's the catch, if the keloid was due to her previous cesarean delivery (which you seem to indicate via the O34 diagnosis code), he would be cleaning up a previous incision so you probably don't have a basis for billing (unless the keloid was in a different location that the current incision of course). 58662 is absolutely incorrect as it would have to be laparoscopically and this was performed immediately post abdominal cesarean. But I would not report the Z code. Per the ICD10 guidelines "A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code." As the scar was probably left from the previous cesarean, it would be included in O34. If this scar was due to a myomectomy and is in a different location, you would not use O34, but could use the Z code. For the scar itself you would want to add an L91 code and for the cyst also an L code (depending on what it turns out to be on a path report).