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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Lesions, Masses, and Tumors, Oh My! 

When doctors describe lumps and bumps inconsistently, look to the definitive diagnosis for clarity. Coding lesions, masses, and tumors can be tricky because some providers use these three terms interchangeably in the same operative note. By the time youve finished reading the note, you don’t know what type of lump or bump you’re coding. That’s […]

The post Lesions, Masses, and Tumors, Oh My!  appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

CPT code for laser destruction tongue lesions

Our physicians perform destruction of tongue leukoplakia, via C02 ablation. They do this frequently. I have in the past read conflicting forums, some saying code 17000, because even though the code is in the integumentary section of the CPT book, in the code description itself , it does not specify skin, just destruction any method. I have also seen forums stating to use unlisted procedure code 41599. I need some guidance because 41599 is not a payable code, even on appeal with documentation. thanks

Medical Billing and Coding Forum

BREAST TISSUE REARRANGEMENT/ EXCISION SKIN LESIONs

Hello,
I am new to coding breast procedure. Can someone help find the code(s) to the procedure below?

The breast mass excision is 19120. Need help with other codes.

He began the left breast mass excision by excising an ellipse along what I am to be her new IMF. I used her right IMF as a template to design her new left IMF. It was significantly lower and more medial than her current left IMF which had been distorted superiorly and laterally by a large 4 x 3 cm bluish medial left inframammary fold mass. Please see his dictation for the excision portion of the procedure.
While he was working on the left side I began on the right side. With a scalpel I excised all 3 lesions previously discussed .These included a 1 cm irregular brown pigmented nevus of her right areola halfway between the nipple base and area lower margin. The length of the ellipse excised measured 2 cm to include 5 mm margin. In addition I excised a 6 mm dry crusty nonpigmented raised lesion of the sternum to the right of midline. A 2.5 cm ellipse of skin was excised to include a 5 mm margin. Finally I excised the 1 cm round raised subcutaneous lesion of the right upper chest wall with a 3 cm ellipse of skin along the midclavicular line. They were all sent to pathology for examination. Hemostasis was achieved using electrocautery. All 3 areas were injected with a total of 20 cc of quarter percent Marcaine with epinephrine for anesthesia. The lesions were irrigated with normal saline. They were closed in layers using 4-0 Polysorb in the dermis and 4-0 Biosyn the subcuticular layer.
Once Dr. completed the left breast mass excision I mobilized the left breast tissue off the pectoralis. Care was taken to maintain the superior medial and lateral blood supply to the breast tissue and nipple areolar complex. I then incised the left breast IMF to allow it to descend approximately 1.5 cm to match the contralateral side. I tacked the skin down using 2-0 Polysorb sutures to re-create the new inframammary fold. Then using 2-0 Polysorb interrupted figure-of-eight sutures I medialized the breast tissue to fill the defect left after excising the left breast mass. The patient was sat upright 90 degrees to assess the symmetry and new contour of the breast. A small amount of additional redundant skin along the new IMF was resected using the tailor tacking technique. Patient was returned to prone position. The left breast pocket was irrigated with normal saline. Hemostasis was achieved using cautery. And is 30 cc of quarter percent Marcaine with epinephrine was injected for local anesthesia. The incision was then closed in layers using 3-0 Polysorb in the dermis and 4-0 Biosyn subcuticular layer. Dermabond prineo was placed over all of the incisions. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.

Thanks in advance :)
*

Medical Billing and Coding Forum

Palmetto GBA LCD L33445 removal of skin lesions

Palmetto GBA became our MAC at the beginning of the year. With that comes their LCD L33445 Removal of Benign and Malignant Skin Lesions with (or in this case without) a different set of "covered" or "deemed medically necessary" ICD-10 codes. This has really shook the physicians in terms of treating lesions that we are used to treating day in and out. They are scratching their head for example as to how/why only a few cyst codes are covered and others are not (specifically Pilar Cyst which they excise quite commonly in our practice). I wondered if anyone would share what your experience is when moving to a new MAC and getting through this transition. What is the recourse when you send in a claim that is automatically hitting an edit? I have a provider who is adamant Pilar Cyst needs to be on the list and asked if I could get someone on the phone for her to speak with about it.

What is the recourse? The appeal chain? Is that what we try to do in order for her to try to appeal to someone’s medical sense to reimburse these claims? I have offered a few suggestions to the physician – for example: Is a pilar cyst more subcutaneous and perhaps Palmetto feels the excisions should be coded with the musculoskeletal codes? She didn’t feel that was appropriate.

I have several questions and claim examples with varying issues but my ground level question at this point is – What do you guys do when this comes up? We can’t just wait and hold out hope that a revision to the LCD comes along that fits our case. We have claims that need to get out the door now.

I’ll appreciate your feedback

Medical Billing and Coding Forum

Destruction of Malignant Lesions by injection

My provider has a patient with a squamous cell carcinoma on their leg. He is injection Fluorouracil 500 mg (J9190) directly into the lesion. When we are using our EHR it is producing code 96405 and we believe it should be in the 172.. codes (Destruction Malignant Lesions, Any method)

Thoughts from anyone out there in the Dermatology field and what you may be doing.

Thank you

Medical Billing and Coding Forum

Risk factor for destruction of lesions?

Hi,
We are having a debate whether destruction of benign or malignant lesions 17000-17110 are considered a *Minor Surgery WITH Identified Risk Factors, or Minor Surgery WITH NO Identified Risk Factors* under the Management Options category when coding EM levels.
For example sake, lets say pt otherwise has 3 additional diagnoses plus treatment for AK, a Detailed History and EPF skin exam, no additional treatment.
Note says pt was told what to expect after the procedure (blistering, bleeding, flake and fall off in a few days etc) and pt is given post treatment instructions. We have considered this under LOW risk (minor surgery with no identified risk factors) and are being told it should be considered as MODERATE with identified risk.

How would you consider the risk factor for this type of procedure and why?
Thanks!

Medical Billing and Coding Forum

LCD for Benign Skin Lesions

I am wondering about how to code medical necessity for benign skin lesions for Medicare. LCD L34233 (Noridian) says the following:

Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain

However, the secondary ICD 10 codes in List III of the LCD are so specific they don’t necessarily address these, specifically "pain." If my provider notes that a sebaceous cyst is painful/irritating to the patient, that is medical necessity according to the LCD, but none of the codes in List III are about pain or irritation in general. I don’t know how to code these so that Medicare will pay.

Any ideas? There used to be a Z code (if I remember right) that was a catch-all for medical necessity in these types of cases, but I don’t see it on the LCD anymore.

Medical Billing and Coding Forum

How to code cystourethroscopy with two lesions removed

Hello fellow coders,

I am very unfamiliar with coding this particular specialty. Please help me if you can.

Scenario: Cystourethrocopy with two lesions removed from different locations in bladder. One is 1.6 cm bladder tumor of the lateral wall. The other is 0.9 cm in the anterior wall. What coding rule applies? :confused:

a. Code the cystourethrocopy only.
b. Code using two CPT codes with modifier 59.
c. Code the largest tumor only.
d. Code using two CPT codes.

Thanks for your help with this! :)

Respectfully,

Charity

Medical Billing and Coding Forum

Cystourethroscopy with two lesions removed

Hello fellow coders,

I am very unfamiliar with coding this particular specialty. Please help me if you can.

Scenario: Cystourethrocopy with two lesions removed from different locations in bladder. One is 1.6 cm bladder tumor of the lateral wall. The other is 0.9 cm in the anterior wall. What coding rule applies? :confused:

a. Code the cystourethrocopy only.
b. Code using two CPT codes with modifier 59.
c. Code the largest tumor only.
d. Code using two CPT codes.

Thanks for your help with this! :)

Respectfully,

Charity

Medical Billing and Coding Forum