Integumentary Practice Codes

• 50200 (Renal biopsy; percutaneous, by trocar or needle)

• 76942 (Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), Imaging S and I)

Under ultrasound guidance, a percutaneous needle biopsy of the kidney was performed

1005

Under ultrasound guidance, an FNA biopsy of the kidney was performed.

10005 (Biopsy, skin lesion, fine needle aspiration)

Ultrasound guidance, the surgeon performed a fine needle aspiration (FNA) biopsy of the epididymis

11104

After local anesthesia was administered, a 3-mm punch biopsy was used to obtain a biopsy of the scalp skin lesion to rule out malignancy.

50200; 77012

Under CT guidance, a percutaneous needle biopsy of the kidney mass was percutaneous.

11102

A patient was seen by the dermatologist for suspicious raise lesion of the chin. The physician used a razor blade to shave the top of the .5-cm lesion for a  pathologic analysis. The patient will make an appointment to discuss the results of the pathology report, which will determine further treatment. 

10005

The patient presented with a left thyroid mass, With the use of ultrasound, the mass was identified and an FNA was performed.

11042

A patient had a grade III ulcer of the left heel. The physician debrided the 4-cm x 2 cm x .5 cm ulcer to the subcutaneous tissue. A number-15 blade was used to remove the fibrinous tissue.

11005; 11008

A patient had a mesh inserted an inguinal hernia repair . Two years later, the patient presented for removal of the infected mesh and debridement of the necrotic tissue. The physician performed a debridement of the wound, including the fascia, and removed the mesh. 

11011

A patient was involved in a motorcycle accident and sustained a fractured fibula. The wound was debrided down through the subcutaneous tissue into the muscle for removal of debris (gravel and glass).

11005

The surgeon performed debridement down to and including the fascia of the abdominal wall due to necrotizing fasciitis.

11043

A patient was seen for treatment of a diabetic foot ulcer (4.0 cm x 3 cm). The surgeon performed a surgical debridement of the skin, subcutaneous tissue, and extensor digitorum brevis muscle. 

11043

The physician debrided a 3.0-sq. cm. wound of the buttocks (in the muscle) and another 4.0 sq cm. wound (in the muscle) of the heel

11043;11044

The physician debrided a 3.0-sq. cm. wound of the buttocks (in the muscle) and another 4.0-sq. cm. wound (in the bone) of the heel.

11604

The physician excise a malignant melanoma of the back that was reported as 3.0 cm x 2.0 cm. Documentation in the operative report states that .5 cm margins were excised around the lesion.

11421; 11421; 11402

The physician excise three benign skin lesion. The excised areas were 2.0 cm from the arm, 0.8 cm from the hand, and 1.0 cm from the neck.

11643

The physician excised a 1.0-cm squamous cell carcinoma from the forehead. The excision required margins of 1.0 cm around the lesion.

17271;17270

The patient has two malignant lesions on the neck, 0.5 cm and 0.8 cm destroyed by electrosurgery.

17111

Laser removal of 16 benign skin lesions from the back

11056

Paring of three hyperkeratotic lesions from the patient’s foot 

Intermediate closure

what kind of closure?

• A surgeon documents that the defect was to the epidermis, dermis, and subcutaneous tissue. Procedure description includes that the absorbable sutures were placed within the subcutaneous tissue and deep dermis. To close the defect, the surgeon placed epidermal sutures in interrupted or running fashion

complex closure

which closure?

• Wound edges were undermined extensively. Buried absorbable sutures were used to close the subcutaneous and dermal components of the defect. Simple interrupted sutures were used to approximate the epidermal edges.

12002

A physician performed simple wound repair of two lacerations of the arm measuring 2.5 cm and 1.5 cm. The sum of the two lacerations is 4.0 cm

12032

A patient was treated in the ED for a deep 7.0 cm wound of the back. A routine cleansing and deep nonmuscle layer closure were required. 

12001

A child was seen in the physician’s office for a superficial laceration of the right knee. The physician repaired the 2.5 c.m laceration with simple suturing

12002; 12041 (Sum of pairs)

A patient was treated for multiple wounds of the right forearm, hand, and knee. The physician sutured the following: simple repair, 2.5 cm forearm; intermediate repair, 1.5 cm hand; simple repair, 2.0 cm knee

15150

A 35-year-old patient sustained third-degree burns.  A small skin graft was harvested at the time and submitted for tissue culturing. Three weeks later, the patient was admitted for grafting of the cultured tissue. A total of 20 sq cm was grafted onto the patient’s arm during this second encounter.

14021

A physician performed a wide resection of a 3.0-cm malignant skin lesion of the left leg. The defect required an adjacent tissue transfer measuring 15 sq cm.

15200

A surgeon performed a full-thickness skin graft, harvesting skin from the buttocks and grafting it ot the chest to cover the 2 cm x 4 cm defect.

15576

A surgeon performed a tubed pedicle flap from the forehead to cover the defect on the nose.

17000, 17003, 17003

The physician destroys three lesions determined to be actinic keratoses. 

19350

Nipple Reconstruction

19125

Excision of breast lesion after insertion of localization marker

19357-50 

Bilateral breast reconstruction at same operative session as mastectomy using tissue expanders

19303-22

Skin-Sparing mastectomy without lymphadenectomy

19318

Breast reduction

16020

Debridement and dressing of first-degree (partial thickness) burn of the index finger

11043

Debridement of below-knee amputation stump.

The necrotic wounds were sharply excised down to and including the fascia with a 10-blade scalpel (15 sq cm.)

12032

Intermediate, layered closure of 2.0 cm laceration of right forearm and intermediate closure of 2.5 cm laceration of left elbow

10007

FNA biopsy of mass in chest, under fluoroscopic guidance.

11606

Excision of malignant melanoma of left arm (3.0cm x 1.5 cm, with 1.0 cm margins surrounding the lesion).

19303-50; 19369-50

Bilateral total mastectomy with reconstruction using double-pedicle

11750-T5

Complete excision of nail and matrix, right great toe

19083-LT

With the use of ultrasound guidance, the surgeon placed a metallic clip to identify the suspicious tissue in the left breast. A percutaneous needle biopsy was performed. 

17272

Electrosurgical fulguration was used to remove a 2.0 cm squamous cell carcinoma of the hand

14001

Wide excision of a malignant lesion of back (5.0 cm x 3.0 cm) with adjacent skin graft

19303-LT; 19340-LT

Complete mastectomy of the left breast with insertion of breast implant in the same operative session.

19325-50

For cosmetic purposes, the patient electively receives bilateral silicone implants

11442

Excision of left-face sebaceous cyst

12032;12002; 12041

• Left knee: 5.5 cm laceration involving deep subcutaneous tissue and fascia, repaired with layered closure

• Right knee: 7.2 cm laceration repaired under local anesthetic, with a under local anesthetic

• Left hand: 2.5 cm laceration of the dermis, repaired with simple closure under local anesthetic

11646; 15120

Excision of basal cell carcinoma with split-thickness skin graft

11043

Excisional debridement of abdominal wound

111043

The patient has a diagnosis of a decubitus ulcer of the leg. The surgeon debrided the necrotic tissue that extended down to and included part of the muscle.

11646

The surgeon reports that the patient has a 3.5 cm basal cell carcinoma of the chin. The excision required removal of 0.5 cm margins around the lesion.

10060

Operative Note: After local anesthesia was administered, the site was cleansed and an incision was made in the center of the sebaceous cyst. The cyst was drained and irrigated with a sterile solution. Diagnosis: sebaceous cyst of back.

12032; 12013; 11043

A patient is seen in the Emergency Department after an accident. A 6.0 cm deep wound of the upper arm (located in area of nonmuscle fascia) required a layered closure, and a 4.0 cm superficial laceration of the left cheek was repaired.

11308

Operative Procedure: Shaving of a 2.6 cm pyogenic granuloma of the neck removed in total.

17000

With the use of a YAG laser, the surgeon removed a 2.0 cm giant congenital melanocytic nevus of the leg. Pathology confirmed that the lesion was premalignant.

11730-T6; 11732-T7

A physician performs a simple avulsion of the nail plate, second and third digits of the right foot.

19000

Operative Note: Patient seeking treatment for a cyst of right breast. A 21 gauge needle was inserted into the cyst. The white, cystic fluid was aspirated and the needle withdrawn. Pressure was applied to the wound and the site covered with a bandage.

60100

The patient underwent a core needle biopsy of the thyroid gland.

11106; 11105 (pg.15)

Physician performed an incisional skin biopsy for a lesion of the arm and punch biopsy for lesion of the hand

debridement

treatment of damaged or infected tissue.

wound debridement

surgical removal of dead, damaged, or infected tissue to help the healing process.

single wound

The coding decision is based on the deepest level and documented size

multiple wounds

Add surface areas of wounds of same depth.

• Do not add if separate wounds are different depths.

• Report all different levels with different codes

both

wound closure need how may code series with simple closure but any other closure is separate

largest 

Excision of Lesions

• If margins are not documented by the surgeon, you can only use the ______ documented diameter of the lesion. •For dimensions of 1.9 cm x 0.5 cm x 0.8 cm, the greatest diameter is 1.9 cm.

individually

Report every excised lesion _______— unless multiple lesions are excised with a one incision.

benign

lipomas are benign or malignant

NO

does curretement change the code for destruction codes?

-51

which modifier should you add for different areas of destruction?

HCPCS

Medicare does not allow coding CPT code for repair with tissue adhesive. Instead use: ______ code G0168 Wound closure utilizing tissue adhesive(s) only

Steri-Strips

Do not code _____-_____, which are part of the E/M code

Limited undermining (intermediate closure)

A technique used in wound repair to separate the skin and subcutaneous tissue from the underlying fascia, allowing the wound edges to be closed with less tension.

complex repair

Scar revision is not automatically considered a ______ repair

lesions

When more than one classification of wounds is repaired, list the more complicated repair first. (#2 under Extensive Undermining in the CPT)

• Only add wound repairs if criteria are met.

• Never add ____. Lesions are always individually reported.