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Help with coding please

  1. Default Help with coding please
    Medical Coding Books
    Surgeon did excision of buttock lipoma subcu tissue with layered closure. Would 27047 be appropriate code and can you also bill for closure separately or would that be included.

    Thanks for your help

    Vicky K

  2. Default
    Procedure code 27047 would be appropriate and includes layer closure.
    Hope this helps!

  3. #3
    St. Louis, Missouri
    I would not use 27047, this is for the pelvis and hip area. You stated that this lipoma was removed from the buttock. I would use an excision of benign lesion code in the integumentary section. Then you would also code for the layered closure.

    Melissa Blow, CPC

  4. Default
    I agree with Melissa.
    ~Amy, CPC, CPMA, CEMC~

  5. #5
    Albany, New York
    I agree with Melissa also.
    Karen Maloney, CPC
    Data Quality Specialist

  6. Default
    Thanks for your help.

  7. #7
    If the incision was in the subcutaneous tissue, I disagree with everyone. Before I responded to this, I wanted to confirm my thinking so I put the question out on another list-serve. Margie Vaught (for those of you that know of her and her awesome reputation) responded with this:

    Please see the below CPT assistant:

    Year: 2006

    Issue: August

    Pages: 12-14

    Title: Coding Communication: Questions and Answers

    Body: Surgery: Integumentary/ Musculoskeletal System

    Question:What is the correct CPT code to report for excision of a lipoma from the
    right flank?

    AMA Comment:From a CPT coding perspective, lipomas are typically benign tumors that may occur sporadically or with an underlying genetic predisposition. In only the rarest of incidences are they anything but benign. While usually asymptomatic, they will produce symptoms due to their location, ie, over bony prominences or in areas that are compressed (eg, the buttocks). Lipomas may be found in multiple locations pathologically. While commonly in superficial tissue, they can also be present in subfascial and submuscular locations. Often the tumors are well defined, but, at times, the lesion may wrap around the nerves and blood vessels, complicating removal.

    When a lipoma is present in a superficial location, it would be appropriate to use an excision code from the integumentary system (eg, 11400-11446, Excision, benign lesion). However, when the lipoma is in a deep subcutaneous, subfascial, or submuscular location, an appropriate code from the musculoskeletal system (eg, 21930, Excision, tumor, soft tissue of back or flank) would be reported to describe more closely the work entailed. Therefore, it will be necessary to consult the procedure report to determine the physician work involved in removing the lipoma.

  8. Default
    I agree with mbort, if it is subq you would use the 21930.

  9. Default
    I'm with pherder - I think the buttock fits the pelvis/hip area better than the back/flank, at least by the definitions in my medical dictionary (Dorland's).

  10. Default
    In the Taber's Dictionary, it states under flank: The part of the body between the ribs and the upper border of the ilium. The term also refers loosely to the outer side of the thigh, hip, and BUTTOCKS.

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