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subcutaneous vs subfascial removal ?

  1. Default subcutaneous vs subfascial removal ?
    Exam Training Packages
    Not sure between codes for subq or subfascial removals of face & back. 21012/21014 & between 21931 vs 21933
    He says he went thru skin and subq tissue but I'm just not sure if that's enough?

    1. 2 x 2 cm fatty tumor right face.
    2. 6 x 6 cm fatty tumor right back.

    The patient is a 72 year old female who has a 2 x 2 cm mass on the right face, just in front and inferior to the ear, and a 6 x 6 cm tumor on the right lateral back, just posterior to the flank, but inferior to the scapula.

    The back is approached first. The skin overlying the marked out lesion is infiltrated with lidocaine. A transverse incision is made. When we come down through skin and subcutaneous tissue, an encapsulated fatty tumor, measuring approximately 6 x 6 cm, is excised. We now irrigate and dry, and oozing is stopped with a Bovie cautery. We infiltrate with Marcaine deeply. The wound is closed in layers using 3 0 Vicryl, deeply, in a continuous fashion, and a second layer of 3 0 Vicryl through the subcutaneous more superficially, and then finally, the skin is closed with a running 4 0 Monocryl subcuticularly. Benzoin and Steri Strips are placed followed by Telfa Bioclusive.

    At this time, attention is turned to the right face. The facial lesion is prepared with Betadine. It is marked out with a sterile marking pen. It is draped out sterilely. The skin is infiltrated with lidocaine 1%. A transverse incision is made, and now after coming through skin and subcutaneous tissue, an encapsulated fatty tumor is dissected away from the surrounding tissue, and any oozing is stopped with a Bovie cautery. The wound is now closed with a running 5 0 nylon. Telfa and Bioclusive is placed.

  2. Default
    any takers on this one please???>

  3. #3
    Greater Pittsburgh
    I would go with the subcu., the note doesn't state the physician went to the fascia/intramuscular.

    Subcu. is fat to the outermostfascial layer; Deep is down deep within the soft tissue, such as into the fascial layer or within the muscle.
    jdemar, CPC, CMA

  4. Default
    thank you

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