Integumentary Flashcards by Kristin Burns

Laceration repairs are performed as follows: simple arm, 2.0 cm; intermediate arm, 3.0 cm; and simple nose, 2.0

12032, 12011-51, 12001-51
1. Repair intermediate 2.6-7.5 cm
2. Simple repair 2.5 cm, modifier 51 for multiple procedures
3. Simple repair scalp/neck/ax/genitals/trunk 2.5 cm

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Excision of 2.5 cm malignant lesion of arm with 0.5 cm margins. Also removal of 1.5 cm malignant lesion from scalp was performed.

11622 excision malignant lesion 1.1-2 cm
11604-51 excision malignant lesion trunk/arm/leg 3.1-4 cm

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Excision of benign, hyperkeratotic lesions to the right clavicular area, right preauricular area, and right periscapular area. The lesions were all cleaned and subsequently curetted off and cauterized with electrocautery.

11056 paring/cutting benign hyperkeratotic lesion 2-4

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Excision of a 2 cm basal cell carcinoma of the neck with 5 sq cm adjacent flap closure

14040 adjacent tissue transfer/rearrangement 10 Sq cm, removal of lesion is included

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Breast biopsy, percutaneous needle

19100 biopsy breast needle core without imaging guidance

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Diagnosis: Ductal carcinoma in situ, right breast. Procedure: Right partial mastectomy. Incision was deepened through skin and subcutaneous tissue. We dissected a large ball of breast tissue out from the medial right breast and used silk suture to close the lumpectomy site.

19301-RT mastectomy partial

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Excisional breast biopsy, right breast

19101-RT biopsy breast open Incisional

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Destruction of malignant lesion, 2.0 cm face; excision of malignant lesion, 1.5 cm face; and excision of benign lesion, 2.5 cm arm

11642 excision malignant lesion 1.1-2 cm
11403-51 excision benign lesion 2.1-3 cm
17282-52 destruction malignant lesion 1.1-2 cm

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STSG from thigh to arm, 2 x 3 cm

15100 split autograft 100 Sq cm

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Wide excision of presumed basal cell carcinoma on the face, 2.5 cm. STSG was obtained from the left neck and applied to the site of wide excision.

Presumed BCC - not coded as malignant
1. 11443 excision benign lesion 2.1-3 cm
2. 15120 split autograft 1st 100 Sq cm

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Radical excision of 3 cm BCC on nose, repair with FTSG from right preauricular area

11643 excision malignant lesion face 2.1-3 cm
15260 graft free with direct closure face 20 Sq cm (size not specified so smallest is used)

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Excision of leg carcinoma and FTSG. Lesion in the distal leg at the anterior side was 2 cm. Excised the lesion with generous margin. Supposed to do a STSG, but dermatone was not available; therefore, FTSG was obtained from upper thigh, 3 x 1 cm, and applied to leg area.

11602 excision malignant lesion trunk/arms/legs 1.1-2 cm
15220 graft free with direct closure face 20 Sq cm

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Left breast mass. A curvilinear incision was made, and the topical abnormality was grasped with Allis clamps, and circumferential dissection was performed to remove the abnormal mass.

19120-LT excision cyst/aberrant breast tissue open 1> lesion

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A 7-year-old patient has a v-shaped laceration approximately 2.5 cm in length and a small one about 0.5 cm on the right side of the hand. Lacerations are cleaned and closed with 4-0 Ethilon sutures.

12002 simple repair scalp/neck/ax/genitals/trunk 2.6-7.5 cm

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A 42-year-old female presented for removal of two lesions located on nose and lower lip. Lesions were identified and marked. Utilizing a 3 mm punch, a biopsy was taken of the left supratip nasal area. The lower lip lesion of 4 mm in size was shaved to the level of the superficial dermis.

11310 shaving skin lesion face 0.5 cm
11104-59 punch biopsy skin single lesion (modifier -59 indicates that biopsy was performed on separate and distinct site than other lesions)

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The left breast was markedly enlarged, consistent with gynecomastia and benign. The incision was made, and breast tissue that had been previously marked out was dissected free.

19300-LT mastectomy for gynecomastia

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A 4.5 cm (excised diameter) benign cystic lesion from forehead. The ulcerated lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically excised. The wound was closed with a layered suture technique and a sterile dressing applied. The wound closure was 5.3 cm.

11446 excision benign lesion face 4 cm, no code for closure because it was a simple closure

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Malignant lesion removed from the right arm (excised diameter 4.6 cm). During the same visit, the dermatologist noticed a new growth on the left arm. Incisional biopsy of the new lesion was performed and sent to pathology. What code(s) would be assigned?

11606 excision malignant lesion trunk/arm/leg >4 cm
11106-59 Incisional biopsy skin single lesion, modifier -59 to indicate that the biopsy(ies) were performed on a “separate and distinct” area

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Benign neoplasm of the mucous membrane of the mouth. Using a handheld laser set at 15 watts, super pulse power was applied around the circumference of the lesion, and dysplasia circumscribed with the laser. The central tumor and dysplasia were ablated and vaporized with the laser. Two additional benign lesions were identified in the mouth, and the same identical procedure was performed as well.

17110 destruction benign lesions up to 14

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Laceration repair, 1.5 cm face

12011 simple repair face 2.5 cm<, repair is assumed simple since not otherwise stated

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At the site of a previously excised ulcer of the second MPJ joint, an Apligraf skin graft was prepared, cut, and sutured into place.

15275 substitute graft face <100 Sq cm 1st 25 Sq cm

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The physician performed a percutaneous needle core biopsy on a suspicious lump on the patient’s right breast.

19100-RT biopsy breast needle core without imaging guidance

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Laceration repairs as follows: 1.5 cm arm, simple; 2.5 cm arm, simple; 1.5 cm arm, intermediate

12031 repair intermediate 2.5 cm<
the 1.5 cm arm and 2.5 cm arm are summed together and coded to CPT code 12002 simple repair scalp/neck/ax/genitals/trunk 2.6-7.5 cm

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Repair of laceration to the left ring finger

12001 simple repair scalp/neck/ax/genitals/trunk 2.5 cm<, repair isn’t specified so assumed simple, size isn’t specified so smallest size is coded

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Excision of a 1 cm lower back lesion. Lesion on the arm, 1 cm in size, was also excised and closed. Surgical path indicated that lower back and arm lesions were malignant.

11601 and 11601-59 excision malignant lesion trunk/arm/leg 0.6-1 cm

Patient is 4 years old who cut his arm on broken glass. He has a 2 cm laceration on his arm and an additional 1 cm on the right hand. The larger wound as well as the smaller laceration is closed with 4-0 Ethilon.

12002 simple repair 2.6-7.5 cm, lacerations are in same anatomical site and therefore one code only

A patient presents for closure of a 6.5 laceration to the forehead. The wound was repaired and dressing was applied.

12014 simple repair face 5.1-7.5 cm

Treatment of molluscum contagiosum by cryotherapy. Patient was given light sedation, and the two lesions were exposed. Curettage was attempted, but the lesions were not easily removed; therefore, cryotherapy was used to treat each of the lesions through two freeze/thaw cycles.

17110 destruction benign lesions up to 14

Laceration repair right ring finger. Wound was cleansed, and extensive debridement was performed to remove necrotic tissue. Suturing was performed utilizing 4-0 Ethilon sutures.

12041 repair intermediate neck/head/face/extremities/genitals 2.5 cm <, scenario indicated “extensive cleaning,” the repair/closure is assigned an intermediate repair/closure code

Mohs surgery on left arm. Reported routine stains on all slides, mapping, and color coding of specimens. The procedure was accomplished in three stages with a total of seven blocks in the second stage and third stage.

1. 17313 moh's trunk/arm/leg 1st stage 5 blocks 2. 17314 x 2 moh's each stage after 1st 3. 17315 x 2 moh's additional block any stage

Excision of malignant lesion, face, 2.0 cm

11642 excision malignant lesion face 1.1-2 cm

Right breast was prepped, and an incision was made over the breast mass for intended excision. The patient experienced EKG abnormalities, and the physician made a decision to discontinue the procedure and schedule it at a later date.

19120-RT-53 excision cyst/aberrant breast tissue open 1> lesion, modifier 53 to indicate the procedure was discontinued

A patient presents for a 2.5 cm excision of malignant breast lesion identified by preoperative placement of radiological marker.

19125 excision breast lesion preop placement of radiological marker open 1 lesion

Excision of malignant lesion, 2.0 cm leg with 0.5 cm margins

11603 excision malignant lesion trunk/arm/leg 2.1-3 cm (3 cm lesion with margins added)

Incision was made over right axillary abscess. Cultures were obtained and sent to pathology. The wound was packed and dressed.

10060 incision and drainage abscess simple/single (assumed simple since not otherwise stated)

Excisional biopsy of an area of clustered abnormal microcalcifications of the left breast. The patient was brought to the OR after having undergone needle localization earlier in the X-ray suite by the radiologist. A curvilinear incision was made in the upper quadrant, needle was identified, and a wide wedge excision was carried out encompassing the cluster in question. Assign the appropriate codes for the surgeon.

19125-LT excision breast lesion preop placement of radiological marker open 1 lesion

A patient underwent an excision of a 4.0 cm diameter malignant lesion on her nose. A 20 sq cm adjacent tissue transfer was required to repair the primary and secondary defect sites.

14061 adjacent tissue rearrangement eye/nose/ear/lip 10.1-30 sq cm (excision of lesion not separately reportable for tissue transfer)

Excision lesion, 2.0 cm leg, and two (2) additional lesions, each 1.0 cm arm.

1. 11402 excision benign lesion trunk/arm/leg 1.1-2 cm 2. 11401 excision benign lesion 0.6-1 cm 3. 11401-59 modifier 59 to indicate the procedure was separate and distinct

Left mastectomy for left gynecomastia, skin tag removal. Areola was elevated off the breast, and breast tissue was excised. Following completion of the breast procedure, right groin was exposed and draped, and skin tag was excised by shave excision.

1. 19300-LT mastectomy for gynecomastia 2. 11200-59 removal skin tags multiple up to 15 (modifier 59 to indicate separate and distinct procedure)

Repair of nail bed

11760 repair nail bed

Adjacent tissue transfer, arm, 20 sq cm with removal of malignant lesion, arm 16 cm

14021 adjacent tissue transfer/rearrangement scalp/arm/leg 10.1-30 cm (lesion excision not separately reportable)

Intermediate laceration repair, 2.5 cm, right index finger

12041 repair intermediate head/face/extremities/genitals 2.5 cm<

Chronic wound requiring STSG. Graft was obtained from the left thigh and placed on a 2 x 4 cm chronic wound of the right hand.

15120 split autograft face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits 1st 100 sq cm

A 4 cm lower lip lesion was excised and diagnosed as malignant. A skin flap was utilized from the nasolabial flap and rotated inferiorly to close the defect.

14060 adjacent tissue transfer/rearrangement face 10 sq cm<

The patient is a 42-year-old female who was discovered to have breast cancer on the right side. She was treated with mastectomy followed by chemotherapy and radiation therapy. She now elects to proceed with reconstruction by single pediculate myocutaneous TRAM flap, which is performed uneventfully.

19367-RT breast reconstruction single pedicled tram flap

Laceration repair, 2.0 cm, face

12011 simple repair face 2.5 cm<

Right modified radical mastectomy was performed as follows: Superior and inferior flaps developed and breast taken off chest wall and axillary nodes removed as well.

19307-RT mastectomy modified radical with axillary lymph node removal

A patient was taken to the x-ray suite where the radiologist under ultrasonic guidance localized the right breast lump with a needle. The patient was then taken to the surgical suite. The localized needle was followed to its termination, and a generous margin was achieved encompassing the needle and node in question.

19125-RT excision breast lesion preop placement of radiological marker open 1 lesion

Lumpectomy, right breast with axillary node dissection. An elliptical incision was made above the areola. Incision was made removing the tumor down to the pectoralis fascia. Axillary dissection was carried out, and Jackson–Pratt placed into the axilla and secured. Breast incision was closed.

19302-RT mastectomy partial with axillary lymphadenectomy

Lesion of the scalp was excised, and an adjacent tissue transfer totaling 4 sq cm was utilized to close the site.

14020 adjacent tissue transfer/rearrangement scalp/arm/leg 10 sq cm<

Basal cell carcinoma. Excision lesion 4.3 x 2 cm left thigh. A lesion slightly over 4 cm was observed on the patient's left thigh. A small portion was removed and sent for frozen section analysis. This returned basal cell carcinoma. Due to size and location of this lesion, the decision was made to excise the lesion and harvest a full-thickness skin graft from his left lower leg. Excision of 5 x 5 cm full-thickness graft was obtained and placed on back table for prep. We returned to the thigh area. All edges were trimmed, and the full graft was placed into the defect and sewn with a running 3-0 Vicryl.

1. 11606 excision malignant lesion trunk/arm/leg > 4 cm 2. 15220 full thickness skin graft free with direct closure s/a/l 20 Sq cm< 3. 15221 each additional 20 Sq cm

Excision of breast mass, 2.5 cm identified on mammogram by preoperative radiological marker

19125 exc breast les preop plmt rad marker open 1 les

Patient has basal cell carcinoma on his upper back. Excision of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks, which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon.

1. 17313 moh's t/a/l 1st stage 5 blocks 2. 17314 each stage after 1st 3. 17315 each additional block any stage

Debridement of bilateral heel decubiti down through muscle

11043 debridement muscle and fascia 1st 20 Sq cm

A cryosurgery was performed to destroy three premalignant lesions for a patient.

1. 17000 destruction premalignant lesion 1st 2. 17003 x2 destruction 2-14 each

Reduction mammoplasty performed on bilateral breasts

19318-50 breast Reduction

A blepharoplasty will be performed on the lower eyelids. A lower incision line was marked approximately 4 mm above the lid margin along the crease. Then using a pinch test with forceps, the amount of skin to be resected was determined and marked. An elliptical incision was performed on the left lower eyelid and the skin was excised. In a similar fashion, the same procedure was performed on the right lower eyelid.

15820-50 blepharoplasty lower eyelid

A patient presents with a benign face lesion of approximately 2.5 cm. Excision was carried out in the usual fashion. In order to close the skin defect, STSG 3 x 3 cm was obtained from the thigh area and applied to the defect in the cheek, approximately 4 x 4 cm.

1. 11443 excision benign lesion 2.1-3 cm 2. 15120 split autograft 1st 100 Sq cm

Procedure: Wide excision of left axillary hidradenitis suppurativa. The elliptical marking was done to the whole area and taken down through the fatty tissue with electrocautery where the excision was taken deep to accommodate prior sinuses and abscess pockets that reached deep into the tissue.

11450 excision Hydradenitis axillary simple/intermediate repair

Excision of nasal lesion and coverage with pedicle flap. Lesion measured 1.3 cm in diameter. The lesion was excised and a flap elevated along the nasal labial area and rotated into anatomical position.

14060 adjacent tissue transfer/rearrangement 10 sq cm<

Right mastectomy was performed 10 days ago. The patient returned to the OR for a planned delayed insertion of a breast prosthesis for reconstruction.

19342-58-RT insertion/replacement breast implant separate day mastectomy

Repair of laceration to the left ring finger

12001 Simple repair 2.5cm<

Extensive basal cell carcinoma (BCC) of the left retroauricular area. Wide excision of BCC. Skin graft was obtained from the left thigh and placed at the excision site.

11640 excision malignant lesion, 15120 split autograft

Excision gynecomastia, right breast. Area was marked and incision made. Margins of the breast around the areola were dissected circumferentially until all breast tissue marked was removed.

19300-RT mastectomy for gynecomastia

STSG from thigh to arm 4 x 4 cm, STSG from thigh to face 3 x 4 cm

15120 split autograft, 15100 split autograft

Mastectomy, radical, right including pectoral muscles and axillary lymph nodes

19305-RT mastectomy radical w/pectoral muscles and axillary lymph nodes

A patient presents for closure of a 6.5 laceration to the forehead. The wound was repaired and dressing was applied.

12014 Simple repair 5.1-7.5cm

Repair of right index finger laceration. Severely lacerated distal interphalangeal joint of finger from skill saw. Block performed, and extensive debridement performed prior to closing with 4-0 black Ethilon.

12041 repair intermediate 2.5cm<

Patient has burns noted on both hands and arms, blisters intact on left hand as well as right hand. Silvadene and nonadherent dressing applied and wrapped in kling.

16030 dressing and debridement partial thickness burns

U/S-guided needle localization of right breast lesion was performed the morning of the scheduled surgery. Excisional biopsy of right breast lesion; entire lesion sent to pathology revealed fibroadenoma of the right breast. What code(s) would be assigned for the excision of the lesion performed by the surgeon?

19125-RT excision breast lesion preop placement of radiological marker open 1 lesion

Redundant skin of the superior eyelids was demarcated, and the skin and orbicularis were incised, elevated, and excised. Redundant skin was isolated and excised.

15822-50 blepharoplasty upper eyelid

An 84-year-old patient presents to a wound care center with bilateral lower extremity venous stasis ulcers. Five wounds were debrided through subcutaneous tissue in an excisional fashion.

11042 debridement subcutaneous tissue

A patient presents for removal of splinter in foot. Appears to be a small wood splint directly beneath the skin. Incision was made, and after some minimal probing, the splinter was removed.

10120 incision and removal foreign body subcutaneous tissue simple

A left curvilinear breast incision was made, and tissue divided down to the firm palpable mass. A silk retraction suture was placed through the area in question, and dissection performed to remove the spherical-shaped 5 cm tissue sample.

19101-LT biopsy breast open incisional

Integumentary Flashcards

(74 cards)