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Peeling Back the Layers an in Depth Look at Integumentary Coding

Biopsies and I

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Peeling Back the Layers an in Depth Look at Integumentary Coding

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    1. Peeling Back the Layers…an in Depth Look at Integumentary Coding Presented by Dawn R Cloud, CPC, CMSCS

    2. Biopsies and I&D’s 10021-10022 Fine Needle Aspiration 11100-11101 Biopsy of skin 10040-10180 I&D’s

    3. Debridement's 11000-11001-Infected skin 11004-11008-Necrotizing Soft Tissue 11010-11012-Associated with open FX’s 11040-11044-Debridement other

    4. Paring, Skin Tags, and Shaving 11055-11057 Paring of corns and callus’ 11200-11201 Skin tags 11300-11313 Shaving of Lesions

    5. Excisions: Lesions, Tumors, Neoplasm, Etc. Definition: a new, often uncontrolled growth of abnormal tissue; tumor. Thesaurus: bump, cancer, carcinoma, cyst, growth, Lesion, lump, mass, neoplasm, sarcoma, swelling

    6. Benign Lesions Total Excised Area Anatomic Location Depth of Repair

    7. 11400-11406: Excision, of benign lesion including margins, except skin tag (unless listed elsewhere), trunk arms or legs 11420-11426: Excision, of benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia 11440-11446: Excision, of benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membranes

    8. Malignant Lesions Total Excised Area Anatomic Location Depth of Repair Re-excision for Margins 1) During Same Surgical Session (total area) 2) Subsequent Surgical Session (modifier -58)

    9. 11600-11606: Excision, malignant lesion including margins, except skin tag (unless listed elsewhere), trunk arms or legs 11620-11626: Excision, malignant lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia 11640-11646: Excision, malignant lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membranes

    10. Repair Rules Determine length in CM, depth, and location Add together repairs in same depth and location Decontamination/Debridement is separate only when it is extensive Repair of nerves, blood vessels, and tendons are separately billable

    11. Repairs 12001-12021 Simple (superficial) 12031-12057 Intermediate (layered closure) 13100-13160 Complex (More than layered-includes scar revision)

    12. Musculoskeletal Section Excision of soft tissue tumors Definitions added to the Musculoskeletal System subsection to: 1) Define procedures 2) Explain appropriate method of code selection 3) Direct user to report other services related to appreciable vessel exploration and/or neuroplasty and complex soft tissue repair or reconstruction

    13. 4) Clarify that simple or intermediate repair is not reported separately 5) Direct user to report extensive undermining or other techniques when complex repair is required 6) Clarify that dissection or elevation of tissue planes to permit tumor resection is not separately reported 41 new codes, 53 revised codes, 7 deleted codes

    14. Head: Excision •21011 Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm •21012 2 cm or greater •21013 Excision, tumor soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm •21014 2 cm or greater

    15. Neck (Soft Tissues) and Thorax ?21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm #•21552 3 cm or greater ?21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm #•21554 5 cm or greater

    16. Back and Flank ?21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm • 21931 3 cm or greater •21932 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm •21933 5 cm or greater

    17. Abdomen ?22900 Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm •22901 5 cm or greater •22902 Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm •22903 3 cm or greater

    18. Shoulder ?23075 Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm #•23071 3 cm or greater ?23076 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm #•23073 5 cm or greater

    19. Humerus (Upper Arm & Elbow) ?24075 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm #•24071 3 cm or greater ?24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm #•24073 5 cm or greater

    20. Forearm & Wrist ?25075 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm #•25071 3 cm or greater ?25076 Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); less than 3 cm #•25073 3 cm or greater

    21. Hand and Fingers ?26115 Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous #•26111 1.5 cm or greater ?26116 Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm #•26113 1.5 cm or greater

    22. Pelvis & Hip Joint ?27047 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cm #•27043 3 cm or greater ?27048 Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cm #•27045 5 cm or greater

    23. Femur (Thigh Region) and Knee Joint ?27327 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm #•27337 3 cm or greater ?27328 Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cm #•27339 5 cm or greater

    24. Leg (Tibia and Fibula) and Ankle Joint ?27618 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm #•27632 3 cm or greater ?27619 Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm #•27634 5 cm or greater

    25. Foot and Toes ?28043 Excision, tumor, soft tissue of foot or toe, subcutaneous tissue; less than 1.5 cm #•28039 1.5 cm or greater ?28045 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm #•28041 1.5 cm or greater

    26. How Does This Add Up? 21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm 2009 Medicare Allowable $407.78

    27. How Does This Add Up? 11403 Excision, of benign lesion including margins, except skin tag (unless listed elsewhere), trunk arms or legs; excised diameter 2.1 to 3.0 cm 2009 Medicare Allowable $179.27 12032 Repair, Intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet) 2.6 cm to 7.5 cm 2009 Medicare Allowable $261.95

    28. How Does This Add Up? 21930 = $407.78 12032, 11403= $261.95 + $89.64 (50% multiple surgery reduction) = $351.59

    29. Nails 11719-11721- trimming and debridement 11730-11732- avulsion of nail plate 11740- evacuation of subungual hematoma 11750-11752- excision 11755- biopsy

    30. Nails 11760- repair 11762- reconstruction 11765- wedge excision of skin

    31. Pilonidal Cyst 11770-11772- excision based on how complex I&D see 10080-10081

    32. Introduction 11900-11901- injection intralesional 11920-11922- tattooing 11950-11954- injection filling material 11960-11971- tissue expanders 11975-11983- drug delivery implant

    33. Adjacent tissue Transfer 14000-14350 Includes excision of lesions (do not report 11400 or 11600 series) Not used for rearranging and repair of traumatic wounds Undermining alone without additional incisions, do not use these codes, use 13100-13160

    34. Skin Replacement and Substitutes Rules Coded by size and location Code first surgical procedure then skin graft Repair of donor site requiring skin graft is reported separately Do not report for simple grafting, must require anchoring by surgeon to be reported in this section

    35. Skin Replacement and Substitutes Rules Apply definition to codes that reference 100sq cm or 1% body area of infants and children: 100sq cm applies to age 10 and up. %of body surface to infants and children under 10

    36. Skin Replacement and Substitutes 15002-15005 initial wound site preparation 15040 harvesting for cultured skin graft 15050 pinch graft for small areas up to 2cm 15100-15261 autologous skin grafts a) 15150-15157 autologous tissue cultured epidermal grafts b) 15170-15176 acellular dermal replacement

    37. Skin Replacement and Substitutes 15300-15366 allograft skin grafts a) 15300-15321 allograft skin grafts b) 15330-15341 acellular dermal allograft replacement c) 15360-15366 tissue cultured allogeneic dermal substitute

    38. Skin Replacement and Substitutes 15400-15430 xenograft skin grafts a) 15400-15421 xenograft skin grafts b) 15430 acellular xenograft replacement

    39. Flaps and Grafts Skin flaps 15570-15731 Muscle flaps 15732-15738 Other flaps 15740-15776

    40. Other Procedures 15780-15879 Consists mostly of plastic (cosmetic) procedures 15851-52 removal of sutures 15920-15999 Pressure ulcers

    41. Burns 16000-16030 local treatment of burns by % of body surface and depth of burn, does not included skin grafts (see 15100-15431) 16035-16336 Escharotomy

    42. Destruction Rules Any benign, premalignant, or malignant With or without curettement Includes local anesthesia Not usually requiring closure Any method- electrosurgery, cryosurgery, laser and chemical treatment

    43. Destruction 17000-17004- premalignant (AK’s ) 17106-17111- vascular proliferative (2 methods) 17250- chemical cauterization 17260-17286- Malignant by site and size 17311-17315- mohs microsurgery 17340-17999- other

    44. Breast Rules Excision includes certain biopsies, removal of cysts, and surgical treatment May be percutaneous or open Involving removing differing amounts of tissue

    45. Breasts 19000-19030- incisions 19100-19103- Biopsies 19105- ablation 19110- nipple exploration 19112- excision lactiferous duct 19120- excision cyst one or more

    46. Breasts 19125-19126- excision lesion with marker 19260-19272- excision chest wall 19290-19298- introduction procedures

    47. Breast 19300-19307- Mastectomies 19300- gynecomastia (male) 19301-19302- partial 19303- simple, complete 19304- subcutaneous 19305-19307- radical

    48. Breast 19316-19396-Repair and Reconstruction 19316- mastopexy 19318- reduction mammaplasty 19324-19325- augmentation mammaplasty 19328-19330- removal

    49. Breast 19316-19396-Repair and Reconstruction, continued 19340-19342- insertion 19350-19355- nipple procedures 19361-19369- reconstruction 19370-19499- other

    50. Global Periods and Modifiers Remember codes in this section carry 10-90 day global periods (check your guidelines) Use appropriate modifiers- 25,24,57,58,78, and 79

    51. Presented By: Dawn R Cloud, CPC, CMSCS Please feel free to contact her regarding any material presented, OR If you require any help in your practice for the following: Consulting Billing Baseline Chart Audits Coding Issues dcloud213@netzero.net 480-516-7728

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