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subcutaneous lipoma

  1. #11
    Oak Ridge
    Medical Coding Books
    Going way back to an article that was published in the Coding Edge in May of 2003 by a Mary Nell Waldrup, CPC, CCP stated the following under the heading Lipomas, "Lipomas originate in the subcutaneous tissue and are coded, according to site, from the soft tissue excision codes, which are found in the Musculoskeletal section or from codes in the Integumentary section of CPT(R). Do not bill repair separately since the soft tissue site specific codes include the work required for repair. Small lipomas of less than 2 centimeters may be coded with the excision and repair codes from the benign lesion excision section of CPT(R), as appropriate, depending on the required repair. The AMA CPT(R) Assistant, August 2002, states, 'When lipomas are excised from skin or subcutaneous tissue, it would be appropriate to utilize the integumentary system excision of benign lesion codes (11400-11446). When the lesions are located in deep subfascial or submuscular tissues, the appropriate code from the musculoskeletal system should be reported to describe the work entailed.

    There is a newer CPT Assistant Article from August 2006 that states, "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 is necessary to consult the procedure report to determine the physician work involved in removing the lipoma.

    The question I have is what constitutes "superficial location" when these lipomas originate in the subcutaneous tissue?

    Even more recent the soft tissue tumor codes have been revised to include size as of 2010. The January 2010 CPT(R) Assistant Article regarding Excision of Subcutaneous Soft Tissue Tumors seems to directly include the lipomas as it states, "the codes for excision of soft tissue subcutaneous tumors are the most frequently used codes in the Musculoskeletal System section. Of the subcutaneous lesions (found above the deep fascia), the most commonly coded subcutaneous lesions found above the deep fascia are usually benign soft tissue tumors such as lipomas. New codes were created to accurately describe these services in those anatomic sites not previously listed. All soft tissue tumor excision codes include the surgical approach and routine exposure, as well as the simple and intermediate wound closures. Extensive nerve and vessel exploration (eg, femoral artery and vein) and complex wound closures are not included, as they would be rare for these lesions."

    So when my provider removes 19 lipomas from different sites 2cm and greater and states, "Each area had been marked preoperatively. An incision was made over each palpable mass, carried into subcutaneous tissue with sharp dissection and electrocautery. Then using electrocautery and blunt dissection, each lipoma was dissected free from the surrounding tissue and removed. Hemostasis was obtained with electrocautery. All the incisions were closed with 4-0 Monocryl subcuticular sutures and Dermabond."

    I would expect these to be coded in from the Musculoskeletal section as these were dissection from the subcutaneous tissue and were closed in layers. These were clearly not removed from the skin, eg epidermis, or dermis which would to me be in a superficial location.

    Can I get a current experts opinion on this please? What would be considered a "superficial location"? Have we correctly coded the above from the Musculoskeletal section?

    There have been different articles published regarding lipomas and I would like to be the most accurate as possible


  2. #12
    Fort Worth Texas
    I agree that you have coded these correctly with the musculoskeletal section. I also agree that these are not from a superficial location. When we remove that many we have to submit documentaton as they are frequently denied on first pass.
    Michelle Cook,CPC, CPCO, CPMA, CEMC, CGSC, CPEDC,
    2017 AAPC MACRA Proficient

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