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Stuck on this one

  1. #1
    Location
    NEW ORLEANS
    Posts
    956
    Default Stuck on this one
    Medical Coding Books
    Need to see what someone else would code

    Patient hasd an excisional biopsy of right upper arm mass
    PATH report came back as a benign skin cyst

    Procedure in detail
    The right upper arm was prepped and draped in a sterile fashion. A 10 CC of lidocaine with epinephrine were injected for local anesthesia. A transverse incision was made directly over the mass with sharp dissection. Electrocautery was used to dissect the subcutaneous tissue to excise the mass with groossly neagative margins. There was no sign of infection. The wound was irrigated with normal saline. Flaps were moblized with electrocautery in the subcutaneous tissue superiorly and inferiorly followed by 2 cm. The wound was irrigated with normal saline. The subcutaneous tissue was closed with interrupted 3-0 Vicryl suture and 4-0 nylon mattress and simple sutures were usrd to close the skin.

    Now doc office wants to code it 24075 ,while another coder where i work says its 11402. Who is right and who is wrong? or either , and if so please say why for this debate can be over thanks trent

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default
    See if this helps (from Encoder Pro)
    The physician removes a tumor from the soft tissue of the upper arm or elbow area that is located in the subcutaneous tissue in 24071 and 24075 and in the deep soft tissue, below the fascial plane or within the muscle, in 24073 and 24076. With the proper anesthesia administered, the physician makes an incision in the skin overlying the mass and dissects down to the tumor. The extent of the tumor is identified and a dissection is undertaken all the way around the tumor. A portion of neighboring soft tissue may also be removed to ensure adequate removal of all tumor tissue. A drain may be inserted and the incision is repaired with layers of sutures, staples, or Steri-strips. Report 24075 for excision of subcutaneous tumors whose resected area is less than 3 cm and 24071 for excision of subcutaneous tumors 3 cm or greater. Report 24076 for excision of subfascial or intramuscular tumors whose resected area is less than 5 cm and 24073 for excision of subfascial or intramuscular tumors 5 cm or greater. (emphasis added by FTB)

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    NEW ORLEANS
    Posts
    956
    Default
    yes but I dont where he went into soft tissue ?

  4. #4
    Default
    I would like some clarification too. so if the 24075 is in the subcutaneous tissue then when would we use the integumentary codes. It seems to me that they have these new codes to do away with coding an excision with an intermediate closure..??? I am really confused.
    Last edited by ASC CODER; 03-17-2010 at 02:46 PM.
    LG CPC,CASCC

  5. #5
    Default
    I agree with FTB. "subcutaneous tissue beneath the skin"...code from
    "musculoskeletal section"
    NoRaX

  6. #6
    Location
    Philadelphia, PA
    Posts
    95
    Smile
    Hi
    Code 24075 specifically states, subcutaneous, which is above the fascial plane, but below the dermis. All the integumentary codes 11400-11646 are above subq, which wouldnt include any nerves, blood vessels, or muscle. I agree w/Ftessa...24075.

  7. #7
    Default
    tumors that originate at the cutaneous level get integumentary codes.... I understand now.
    LG CPC,CASCC

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