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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

skin re-excisions

Hello

My facility is in a argument about re-excisions of neoplasms

I bill the Pathology end of things only so the dermatology end of things does not pertain to me. I bill off the Pathology report

My question is on Diagnosis codes

Ex: Re-excision of Basal cell carcinoma or R arm, No residual tumor identified, reparative changes present, Incidental Sk

Do I bill the C44.612

Or do I bill L821, with Z code secondary to show that patient had a history of skin Ca at the site?

Thanks

Renae G

Medical Billing and Coding Forum

Re-Excisions of Skin- Pathology coding

Hello

My facility is in a argument about re-excisions of neoplasms

I bill the Pathology end of things only so the dermatology end of things does not pertain to me. I bill off the Pathology report

My question is on Diagnosis codes

Ex: Re-excision of Basal cell carcinoma or R arm, No residual tumor identified, reparative changes present, Incidental Sk

Do I bill the C44.612

Or do I bill L821, with Z code secondary to show that patient had a history of skin Ca at the site?

Thanks

Renae G

Medical Billing and Coding Forum

Skin Grafts- Q4116-Alloderm per square centimeter

I recently found out our facility has some conflicting processes for billing and charging for the Skin Grafts (i.e. Q4116-Alloderm per square centimeter) one of our facilities does not charge per sq. cm, they just charge qty of 1 for the full piece/sheet. Can and should bill for the full amount but just reflect the actual qty that was used? And does anyone know what is the compliant way to handle/report the waste of these products?

Thank you

Medical Billing and Coding Forum

arterial bleeder of the right fifth finger with complete loss of skin of the distal

which CPT code would you use for a right fifth finger with complete loss of skin on the ulnar aspect of the distal phalanx. one point has pulsating bleeding. there are several other points of venous bleeding. The provider infiltrated with lidocaine the did superficial figure of eight suture was placed at the level of the arteial bleeder and at 2 other locations where venous bleeding was most prominent. the bleeding was controlled.
our coders are not agreeing 1 wants to use 35207 with modifier 52, the coder thinks should be simple repair of superficial wound 12001 -12018.. Any suggestions
:confused:

Medical Billing and Coding Forum

Counting skin exam elements, Dermatology

Hello,
We are having a debate after an audit and need clarification on counting elements of a skin exam- 97 guidelines.

In order to count "head, including face" (as listed on the specialty skin exam) Can just the face be examined for your 1 point, or does it have to document BOTH the head AND face were examined in order to get the 1 bullet point.
Same question for "Chest, including breasts and axilla"–Can the chest alone be examined, and count for your 1 point, or do all 3 of those areas need to be examined in order to get the 1 bullet point?

Example- chest, arms and legs were examined. Can the chest count as 1 point, or not at all because breasts and axilla are not listed.

Any clarification is appreciated!

Medical Billing and Coding Forum

Help With Coding Exc of Skin lesion with Full Thickness skin graft & Layered closure

Hi everyone! Just wondering if its appropriate to use the following codes:
Excision of 3 Cm Leison Squamous cell ca of lt hand CPT 11623
with 8 cm layered closure CPT 12044 with 59
and Full Thickness skin graft 15240 (or does the skin graft cover the closure as well)
Thanks in advance for any help with theis matter. DH, CPC

Medical Billing and Coding Forum

AK dx vs CA for skin excision codes

When we have a patient with a lesion that looks like a skin cancer and we excise it for instance- 17280 to 17286 code range, but when the histopathology comes back it was an actinic keratosis, which is a PREMALIGNANT Lesion, does that mean we need to change the CPT code range to 11310 to 11313 code range? That is what I thought since AK are PRE-malignant, not cancer; however our benign lesion LCD does not allow for ICD-10 L57.0 (actinic keratosis). What do you all do in this situation? Thanks for any input!

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