I used to work for General Surgeons, so I am familiar with the soft tissue excision codes from the musculoskeletal part of the CPT book, but I am now coding for Dermatology, and am trying to determine at what depth, is it appropriate to stay in the benign lesion excision area versus when to hop on over to the 2xxxx M/S soft tissue codes. I know the M/S codes say subcutaneous or subfascial, and in the Dermatology practice I’m coding for we are excising these from the subcutaneous tissue, but from the documentation it sounds like it is superficial sub Q, and there is rarely a layered closure.. Will any payers allow the M/S codes to be used in a POS 11? When I coded for General Surgery, these patients were taken to an ASC to have these removed. At the Dermatology practice, they are removing them in our surgical suite with local anesthetic, but it is still POS 11. Our newest PA is also inquiring whether she can bill a first assist for lipoma surgery It is allowed on the M/S codes usually, but only on the larger 114xx codes. Thoughts anyone?
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Tag Archives: Lipoma
Hernia Repair and Cord Lipoma excision with no pathology
Hello everyone, any guidance will be appreciated.
Surgeon performed bilateral inguinal hernias and documented removal of part of cord lipoma on each side but only submitted a specimen for one side. Do I need pathology to code for bilateral? Should the right lipoma bundle since it was "incorporated" in the hernia? I was taught that if the surgeon didn’t sent a specimen to pathology we could not code it.
Thank you in advance.
49505-50
55520-59-50
** right side
** dissection of the cord structures and what appeared to be a cord lipoma incorporated within an indirect inguinal hernia
** further isolated the presumed cord lipoma
** were able to transect a portion of this cord lipoma while reducing the vast majority of it back within the peritoneal cavity.
** indirect inguinal defect
** mesh plug
** incision on the right side was subsequently closed
** attention to the left side
** fat-containing structure
** We separated these 2 structures,
** identified this as a cord lipoma, transecting a small portion of this cord lipoma and subsequently reducing the remainder through
the deep inguinal ring into the peritoneal cavity.
** large indirect defect was noted
** placed 1 large plug and 1 patch
Gross description:
SOFT TISSUE, LEFT CORD LIPOMA, REPAIR:Received in formalin and labeled
with the patient’s name, social security number, and "left cord lipoma"
Microscopic exam/diagnosis:
DIAGNOSIS:
SOFT TISSUE, LEFT SPERMATIC CORD, INGUINAL HERNIA REPAIR: LIPOMA.
Coding removal of lipoma
We have a claim where provider did not document any measurements when removing a mass which was down to the subcutaneous depth. The pathology stated masses were lipomas. A total of 14 were removed from each thigh area. How would we code the removal of these masses since the provider didn’t supply measurements of any of these masses.
Excision of right facial lipoma with facial nerve
Having some difficulty choosing the correct codes for the following:
PREOPERATIVE DIAGNOSIS: Right facial lipoma.
POSTOPERATIVE DIAGNOSIS: Right facial lipoma.
OPERATION: Excision of right facial lipoma with facial nerve
dissection.
FINDINGS:
Surgical findings were consistent with a right cheek/facial lipoma,
which was deep to the SMAS and superficial and adjacent to the right
parotid gland with the facial nerve branches traversing the mass.
The frontal branch of the facial nerve went right through the lipoma
and the buccal and main trunk of the facial nerve was adjacent to,
but not penetrating the mass.
DESCRIPTION OF OPERATION:
The patient was taken to the operating room and placed on the
operating table in supine position and sedated and intubated with
general anesthesia. An endotracheal tube was placed and secured to
the left side of the lower lip. The bed was turned 90 degrees from
anesthesia for this procedure. A surgical time-out was performed,
and all the consents were verified. The facial nerve monitor was
used for this procedure, and was placed on the patient with
electrodes at the orbicularis oculi and orbicularis auris. The
patient was then prepped and draped in a sterile fashion for the
procedure. A marking pen was then used to mark along the marked
incision, which was done in a modified face-lift incision. The
incision followed from the sideburn hairline into the preauricular
crease in a post-tragal fashion, then along the earlobe and carried
slightly posterior to the earlobe along the postauricular area.
Local anesthesia was then used to inject the incision with 1%
lidocaine and 1:100,000 concentration of epinephrine. After
allowing several minutes for the local anesthesia and epinephrine to
take full effect, the procedure began with the marked injected
incision site incised with a #15 blade. A subcutaneous skin flap
was then made extending approximately 3 cm down onto the right cheek
to allow for exposure of the underlying SMAS. Next, the SMAS was
incised just approximately 1 cm anterior to the tragus in the
preauricular area along the length of the mass. A SMAS flap was
then created by carefully dissecting the SMAS off the underlying
tissues. The lipoma was noted to be just deep to this SMAS tissue.
The parotid gland was adjacent to the mass inferiorly and anteriorly
with the mass sitting on the superficial surface of the parotid
gland mostly. Blunt and sharp dissection were then used to
carefully separate the lipoma from the surrounding tissue
attachments. On initial inspection and dissection, a branch of the
facial nerve was noted to be traversing through the middle of the
lipoma. This appeared to be the frontal branch of the facial nerve
and stimulated appropriately with the nerve monitor. Careful
dissection of the frontal branch of the facial nerve that was
traversing the mass was performed separating the mass from the nerve
and mobilizing the nerve allowing the mass to be completely
separated from that branch of the facial nerve. The branch of the
facial nerve was followed inferiorly until the main branch of the
facial nerve which was discovered adjacent to, but not penetrating
or involved in the lipoma. The main branch of the facial nerve was
stimulated appropriately with the nerve monitor. The main trunk of
the facial nerve was not involved in the dissection and did not
require mobilization for removal of the lipoma. All bleeding in the
surgical site was meticulously controlled with bipolar cautery. The
lipoma was separated from the penetrating branch of the facial nerve
and the surrounding tissues were removed in its entirety. The
surgical site was then copiously irrigated with normal saline. The
patient was checked for any evidence of bleeding, which was
controlled meticulously with bipolar cautery. The SMAS flap that
was made previously was then laid down over the underlying parotid
bed and facial nerve that was dissected out and re-sutured to the
surrounding SMAS with 4-0 PDS sutures. This allowed for covering of
the branch of the facial nerve that were exposed as well as help to
avoid any defect or concavity in the face by removing the lipoma.
Next, the skin incisions were then closed with a combination of
running locking 5-0 plain gut suture and running locking 5-0 Prolene
sutures. A compressive dressing was then placed over the surgical
site and the procedure was completed. The patient was turned back
to Anesthesia, where the patient was successfully awakened,
extubated, and taken to recovery room in stable condition. She
tolerated the procedure well without complication. Postoperatively,
in the recovery room, the patient was noted to have full facial
nerve function with no evidence of weakness in any of the branches
on the right side.
At first, I was going to go with 21011 or 21012 depending on the Lipoma’s size (need to query provider) and mention of a subcutaneous skin flap. However the description of going all the way down to the SMAS flaps is pointing me to 21013 or 2014 depending on size since I believe SMAS is subfascial?
In addition, the mention of the lipoma being superficial to the Parotid gland plus the nerve dissection also suggests this could possibly all be coded under 42410 or 42415.
Any help clearing up my confusion here would be appreciated. Thank you.
Excision of right facial lipoma with facial nerve
Having some difficulty choosing the correct codes for the following:
PREOPERATIVE DIAGNOSIS: Right facial lipoma.
POSTOPERATIVE DIAGNOSIS: Right facial lipoma.
OPERATION: Excision of right facial lipoma with facial nerve
dissection.
FINDINGS:
Surgical findings were consistent with a right cheek/facial lipoma,
which was deep to the SMAS and superficial and adjacent to the right
parotid gland with the facial nerve branches traversing the mass.
The frontal branch of the facial nerve went right through the lipoma
and the buccal and main trunk of the facial nerve was adjacent to,
but not penetrating the mass.
DESCRIPTION OF OPERATION:
The patient was taken to the operating room and placed on the
operating table in supine position and sedated and intubated with
general anesthesia. An endotracheal tube was placed and secured to
the left side of the lower lip. The bed was turned 90 degrees from
anesthesia for this procedure. A surgical time-out was performed,
and all the consents were verified. The facial nerve monitor was
used for this procedure, and was placed on the patient with
electrodes at the orbicularis oculi and orbicularis auris. The
patient was then prepped and draped in a sterile fashion for the
procedure. A marking pen was then used to mark along the marked
incision, which was done in a modified face-lift incision. The
incision followed from the sideburn hairline into the preauricular
crease in a post-tragal fashion, then along the earlobe and carried
slightly posterior to the earlobe along the postauricular area.
Local anesthesia was then used to inject the incision with 1%
lidocaine and 1:100,000 concentration of epinephrine. After
allowing several minutes for the local anesthesia and epinephrine to
take full effect, the procedure began with the marked injected
incision site incised with a #15 blade. A subcutaneous skin flap
was then made extending approximately 3 cm down onto the right cheek
to allow for exposure of the underlying SMAS. Next, the SMAS was
incised just approximately 1 cm anterior to the tragus in the
preauricular area along the length of the mass. A SMAS flap was
then created by carefully dissecting the SMAS off the underlying
tissues. The lipoma was noted to be just deep to this SMAS tissue.
The parotid gland was adjacent to the mass inferiorly and anteriorly
with the mass sitting on the superficial surface of the parotid
gland mostly. Blunt and sharp dissection were then used to
carefully separate the lipoma from the surrounding tissue
attachments. On initial inspection and dissection, a branch of the
facial nerve was noted to be traversing through the middle of the
lipoma. This appeared to be the frontal branch of the facial nerve
and stimulated appropriately with the nerve monitor. Careful
dissection of the frontal branch of the facial nerve that was
traversing the mass was performed separating the mass from the nerve
and mobilizing the nerve allowing the mass to be completely
separated from that branch of the facial nerve. The branch of the
facial nerve was followed inferiorly until the main branch of the
facial nerve which was discovered adjacent to, but not penetrating
or involved in the lipoma. The main branch of the facial nerve was
stimulated appropriately with the nerve monitor. The main trunk of
the facial nerve was not involved in the dissection and did not
require mobilization for removal of the lipoma. All bleeding in the
surgical site was meticulously controlled with bipolar cautery. The
lipoma was separated from the penetrating branch of the facial nerve
and the surrounding tissues were removed in its entirety. The
surgical site was then copiously irrigated with normal saline. The
patient was checked for any evidence of bleeding, which was
controlled meticulously with bipolar cautery. The SMAS flap that
was made previously was then laid down over the underlying parotid
bed and facial nerve that was dissected out and re-sutured to the
surrounding SMAS with 4-0 PDS sutures. This allowed for covering of
the branch of the facial nerve that were exposed as well as help to
avoid any defect or concavity in the face by removing the lipoma.
Next, the skin incisions were then closed with a combination of
running locking 5-0 plain gut suture and running locking 5-0 Prolene
sutures. A compressive dressing was then placed over the surgical
site and the procedure was completed. The patient was turned back
to Anesthesia, where the patient was successfully awakened,
extubated, and taken to recovery room in stable condition. She
tolerated the procedure well without complication. Postoperatively,
in the recovery room, the patient was noted to have full facial
nerve function with no evidence of weakness in any of the branches
on the right side.
At first, I was going to go with 21011 or 21012 depending on the Lipoma’s size (need to query provider) and mention of a subcutaneous skin flap. However the description of going all the way down to the SMAS flaps is pointing me to 21013 or 2014 depending on size since I believe SMAS is subfascial?
In addition, the mention of the lipoma being superficial to the Parotid gland plus the nerve dissection also suggests this could possibly all be coded under 42410 or 42415.
Any help clearing up my confusion here would be appreciated. Thank you.
Lipoma Injection
Has anyone come across their doctor doing a lipoma injection along the lumbar region? If so, would you use 11900 for the CPT or do you have a better code for this. Everything I have researched indicates 11900, but I just wanted to be sure. Thanks for your help.