First let me say this
April 2010 CPT Assistant
Integumentary vs Musculoskeletal Lesion Excisions
In an attempt to clear up frequent confusion over which code to report for the excision of soft tissue tumors, the American Medical Association updated guidelines in the 2010 CPT codebook for these types of procedures. Specifically, guidelines for choosing between the integumentary system and the musculoskeletal system were revised, because making the decision between the two systems is where there is the most confusion for coders.
egumentary codes should be reported when the lesion is removed from somewhere within the full thickness of the dermis, and Musculoskeletal codes should be reported when the lesion is removed from the subcutaneous, superficial, or deep soft tissues under the dermis. When reporting an integumentary code, simple closures are included but intermediate and complex closures should be reported separately using CPT codes 12031-12057 or 13100-13153. The removal of Musculoskeletal lesions includes simple and intermediate closures but complex closures are not included and should be reported separately.
With this said, suppose the operative report state removal of lipoma greater than 10cm on leg . it was removed as dissectionn was carrired down through the skin and subcutaneous tissue. The mass clinially did not go down to the fat. The wound was closed with3-0 Vicryl AND 3-0 nylon.
now would you code it as 27337 -which only states subctaneous not subfascial or would you code it in the integumentary system? tHANKS
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