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Wiki Using the 20000 series lesion removal codes

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hillsloan

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I would like feedback on whether or not you believe the DIAGNOSIS drives the use of the "deep" lesion removal codes. If a doctor goes into "subQ fat" to remove a cyst from a patient's back (according to pathology report it's simply a epidermal inclusion cyst) would you use the 21930 code? Other parts of the note say "retractors were placed in the wound. The wound was irrigated and suctioned ... small bleeding points were controlled with cautery". A layered closure was done. Or would you use 11402 with a 21032 closure? Big debate here, looking for your thoughts. Thank you!
 
The procedure code will not change based on DX from path. The procedure rendered is what it is, so if we are going deep into the subcu/fascia, large margins, wide excision, justifies for the 20000 codes.

This is how we do it in our practice

MS:)
 
Normally I agree with sdid123 but got thrown a curve with the January 2011 CPT Assistant Coding Consultation answer to a similar question

"These tumors originate from the dermis or adnexal structures and are not considered soft tissue tumors, even though they may protrude into subcutaneous tissue." CC is referencing an excision of a sebaceous cyst that went into the subcutaneous tissue.
 
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