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Bill 14
| Question | Answer |
|---|---|
| The Integumentary System subsection includes codes assigned by | many different physician specialties. There is no restriction on who reports the coces from this or any other subsection |
| The subsection is formatted on the basis of anatomic site and category of | procedure for example an anatomic sit is neck and a category of procedure is repair |
| subsection integumentary contains the subheadings | skin subq and accessory structures, Nails, Pilonidal Cyst, Introduction, Repair (closure), Destruction, Breast |
| Each subsection is further divided by category.Skin Subcutaneous and accessory structures is divided into the following categories | Introduction and Removal, Incision and Drainage, Debridement, paring or cutting, biopsy, removal of skin tags, shaving of epidermal or dermal lesions, exision-benign lesions, excision-malignant lesions. |
| There are many types of lesions of the skin and many types of treatment for lesions types of treatment include | paring -peeling or scraping-, shaving-slicing-, excision-cutting removal-, and destruction-alation- |
| Lesions Excison and Destruction to code these procedures properly you must know the | site, number, and size of the excised lesion as well as whether the lesion is malignant or benighn |
| Prior to excision, the greates diameter of the lesion is measured. The measurement includes the margin-extra tissue taken from around the lesion- at the | narrowest part. The size of the margin necessary to completely remove the lesion is base on the physicians judgement |
| The pathologyn report is used to | identify the size of the lesion only if no other recxord of the size can be documented because the solution the lesion is stored in shrinks the lesion. |
| All lesion s excised will have a pathology report for | diagnosing the removed tissue as malignant or benign. The billing for the excision is not submitted to payer until the pathology report has been completed |
| If multiple lesions are treated code the most complex lesion procedure first followed by the others using modifier | 51 to indicate that multiple procedures were performed place the service with the highest dollar value amt first without the modifier the payer reduces payment with the modifier |
| If the code description includes multiple lesions state number of lesions modifier 51 is not | necessary |
| Closure of excision sites included in the codes for lesion excision is the direct primary or simple closure of the | operative site |
| excision is defined as | a full thickness through the dermis excision of a lesion. |
| a simple closure is | is a nonlayered closure |
| Closures can be intermediate | layered |
| Closures can be complex | greater than layered |
| The local anesthesia is included in the | excision codes |
| Any closure other than a simple closure can be reported | separately with lesion excisions. |
| 3 notes on treatment of lesions note 1 | The shaving of lesions requires no closure because no incision has been mad |
| 3 notes on treatment of lesions note 2 | Excision includes simple closure but may require more complex closure. If more complex closure is required, follow the notes in the CPT manual to appropriately code for these services |
| 3 notes on treatment of lesions note 3 | Destruction may be any method, including freezing, burning, chemicals, ect. |
| Paring or cutting codes 11055-11057 report the services when a physician removers a benign hyperkeratotic skin leasion such as | a callus or corn |
| Paring codes include removal by | peeling or scraping. A small ring-shaped instrument -curette-, blade or similar sharp instrument is used for paring. bleeding is controlled by a chemical that is applied to the surfaceafter removal of the lesion. |
| Paring and cutting The codes are divided based on the | number of lesions removed |
| Biopsy is a term applied to the procedure of | removing tissue for histopathology -study of microscopic tissue changes- |
| Removing a tissule same of a lesion may be by | needle aspiration-neddle inserted for sampling of cells- incisionalbiopsy-open, sharp, and partial removal or by excisional biopsy-cojplete removal |
| You would not want to report both | a biopsy and an excision performed at the same time as the biopsy is bundled into the excision service |
| Macule | Flat are of color change, no elevation or depression |
| Papule | Solid elevation, less than 1.0 cm in diameter |
| Nodule | Solid elevation 1-2 cm in diameter, extends deeper inot dermis than papule |
| Pustule | Elevated superficial lesion, similar to a vesicle but filled with purulent fluid |
| Tumor | solid mass larger than 2.0 cm |
| Plaque | flat elevated surface found where papules, nodules or tumors cluster |
| Wheal | Temporary localized elevation of the skin; result is transient edema in dermis |
| Vesicle | Small blister, fluid within or under epidermis |
| Bulla | Larger blister, grater than 1.0 cm in diameter |
| Scales | flakes of cornified skin layer |
| Crust | Dried exudate on skin |
| Fissure | Cracks in skin |
| Erosion | Loss of epidermis that does not extend into dermis |
| Scar | Excess collagen production following injury |
| Atrophy | loss some portion of the skin |
| Ulcer | Area of destruction entire epidermis |
| When reporting integumentary wound repsir the following three factors must be considered | Length of the wound in centimenters, complexity of the repair, site of the wound repair-Length, Complexity, and Site |
| Simple superficial wound repair | invloves epidermis, dermis, and subcutaneous tissue and requires onlyn simple, one-layer suturing |
| If the simple wound repair is accomplished with tape or adhesive strips, the charge for the closure is included in the e/M service code and would not | not be reported separately with a repair code. The repair codes are for suture closure. |
| Intermediate closure | requires closure of one or more layers of subcutaneous tissue and superficial-nonmuscle- fascia |
| Intermediate closure | In addition to the skin closure you can report intermdiate closure when the wound has to be extensively cleaned, even if the clousre was a single layer/simple/ closure |
| Complex Closure | Involves complicated wound closure including revision debrdement extensive undermining stents or retention sutrues an dmore than layered closure |
| 3 things are considered components/parts of integumentary wound repair | Simple ligatition , simple exploration, Normal debridement |
| wound repair Simple ligation tying of small vessels is considered part of the wound repair and is not | not reported separately, Simple ligation of medium or major arteries in a wound is howerver, reported separately |
| Wound repair Simple exploration of surrounding tissue, nerves, vessels, and tendons is considered part of the wound repair process and is not listed | separately |
| Wound repair Normal debridement cleaning and removing skin or tissue from the wound until normal, healthy tissue is exposed is not | not listed sparately |
| If the wound is grossly contaminated and requires extensive debridement a separate | debridement procedure may be assigned 11000-11047 for extensive debridement |
| The recipient site is | the area of defect that receives the graft |
| The donor site is | the area from which the healthy skin has been taken for grafting -If a skin graft is required to close the donor site, the closure is reported as an additional procedure. |
| There are many types of adjacent tissue transfers -14000-14350 | Some of them are z-plasty w-plasty v-y plasty, rotation flaps with advancement flaps methods of moving a segment of skin from one area to an adjacent area while leaving at least on sid of the flap-moved skin-intact to retain some measure of blood supply |
| Adjacent tissue transfers are reported according to the sized of the | recipient site. The size is measured in square centimeters 1 inch equals 2.54 cm Simple repair of the donor site is included in the tissue transfer and is not reported separately. |
| If there is a complex closure or grafting of the donor site | this could be reported separately |
| Adjacent Tissue Transfer or Rearrangement is divided based on | locations of the defect-trunk or arm-and the size of the defect |
| when skin grafting is required to cover both the primary defect-results from the excision-and the secondary defect-results from the flap design the | measurement of each defect are added together to determine the code selection for the graft |
| Any excision of a lesion that is repaired by adjacent tissue transfer is included in the tissue transfer code. If you reported the exciaion in addition to the transfer it would be considered | unbundling |
| adjacent tissue transfer codes can be located in the CPT manual index under the main term | main term skin and subterm adjacent tissue transfer |
| Split thickness | epidermes and part of the dermis |
| full thickness | epidermis and all of the dermis |
| Free skin grafts are reported by | recipent site, size of the defect, and type of repair. The size is measured in square centimeters The square centimenters measurement is applied to adults and children over 10 yrs of age and the % of body area is app;ied to infants n children under 10yrs |
| A pinch graft is a | small split-thickness repair often referred to as STSG and full thickness skin graft referred to as FTSG |
| Autograftse | are grafts that are taken from the patients body |
| Allografts | are grafts that are taken from a human donor |
| Acellular dermal replacement | is the use of skin replacement products based on teh location and size of repair Temporary grafts are used to protec defect sites while healing is taking place |
| Permanent graft | may be placed over the site at a later date to complete the repair process |
| Skin cell suspension autografts | are reported with codes 15011-15018 skin cells are harvested and then suspended for a direcgt spray on application can be used for tratmen of burn wounds, necrotizing tissue infections , or resection due to skin cancer. |
| Flaps donor site | report the donor iste when a tube graft is formedfor later use or when a delayed flap is formed before it is transferred |
| Flaps recipient site | is reported when the graft is attached ti its final site |
| Flaps dlayed graft | a portion of the skin is lifted and separated from the tissue below, but it stays connected to blood vessels at one end. |
| Flaps Island Pedicle flam | contains an artery and vein |
| Flaps Neurovascular pedicle flap | contains an artery, vein and nevre |
| Flaps The term island refers to | the removal of the fat and subcutaneous tissue prior to implantation into the recipient site |
| Flaps a neurovascular pedicle flap is used when | the area of defect requires restoration of snsation in the area |
| Dermabrasion | is used to treat acne, wrinkles, or general keartosed horny growth The skin area is anesthetized by a chemical that freezes the area a cryogen and the area is sanded down using a motorized brush. |
| The facial dermabrasion codes are divided according to the | surface area of tyhe face treated total segmental areas other than the face are reported with 15782 |
| Abrasion | used to remove a leasion like a scare tissue, a woart or a callus.This technique is often used to remove areas of sundamaged skin |
| Chenical peels -cosmetic divided according to if on face or not on face in addition to depth of peel epidermal or dermal | also known as chemexfoliation are treatments in which a chemical is applied to the skin and then removed the skin surface will then shed its outer layer much like after a sunburn |
| Blepharoplasty normally for cosmetic purposes | is the rmoval of excess skin and to support the muscles of the upper eylin |
| Rhytidectomy cosmetic | Excision of excess skin and subcutaneous tissue of other parts of the body abdomen thigh buttock and arm most commonly due to bariatric surgery |
| breast procedures incisional biopsy | an icision is made into the lesion and a small portion of the lesion is taken out |
| breast procedures excisional biopsy | the entire lesion is removed for biopsy in some cases it may be necessary to mark the lesion preoperativly by placing a marker to idenify its exact location for depth and position of needle placement to obtain a breast tissue biopsy |
| Partial mastectomy | is one in which only a portion of the breast tissue is removed If an axillary lympahdenectmoy is performed with partial mastexctomy report 19302 |
| Partial mastectomy is also known as | lumpectomy, segmentectomy or tylectomy |
| A smiple or complete mastectomy | is one in which all of the subcutaneous tissue and breast tissue are removed and the nipple and skin may or may not be removed |
| modified radical mastectomy | is one in which the breast is removed in addition to the axillary lymph nodes and the pectoralin minor muscle mayh or may not be removed the pectoralis major muscle is not removed in the modifie radical mastectomy |
| radical mastectomy | is one in which the entire breast is removed in addition to the pectoral muscles and axillary lymph nodes there is another that includes the internal mamary lymph nodes and is alson known as an urban ype operaton |
| brast leasion | is often identified as a rsult of screening mammogram and a breast biopsy is then scheduled |
| tattooing | is reported on square centimeters covered to disguise birthmarks or scars |
| Tissue expander | is an elastic material formed into a sac that is then filled with fluid or air sot it expands like a balloon placed under skin and is filled stretching the skin inplantremoving the expander removing the scre or tattoo and suturin the skin edges together |
| implantable contraceptive capsules | are inserted under the skin by means of a small incision on the upper arm a capsule is effective for anumber of years at the end of that time it must be removed |
| Subcutaneous hormone pellet implantation | is commonly used for the insertion of a hormon in time release capsule into the buttocks of women requiring hormone replacement therapy after menopause |
| lipectomy | liposuction according to body area being treated |
| Integumentary subsection contains subheadings | skin, Nails, pilonidal Cyst, Introduction, Repair/closure,Destruction, Breast, Introduction and Removial, Incision and Drianage, Debridemebnt, Pairing or cutting, biopsy, Revoval of skin tags, Shaving of emidermal or dermal lesions, excision-benin |
Created by:
luci2