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Victoria Posted Tue 02nd of January, 2018 11:55:26 AM
Our physician did excision of multiple lipomas on the chest and back. He coded with 13101 and 13102 x5 for repair of wound but is questioning if that is correct way to code. he indicates approximately 35-40 lipomas were removed. He would remove one and another one would appear.
SuperCoder Answered Wed 03rd of January, 2018 08:44:59 AM

As per documentation provided, the codes that your physician has mentioned seem to be correct for the given scenario, however, in order to assist with the correct way of coding this, we would be needing the details of the procedure performed, as the information provided is not sufficient. Thanks.

Victoria Posted Wed 03rd of January, 2018 13:11:37 PM
Procedure: with the patient under general anesthesia in the right lateral position, all areas were prepared with chlorhexidine and draped. As much as possible, incisions were placed between clusters of lipoma to avoid extra incisions. Through each incision, an average of 3-4 Excision of multiple lipomas of the left chest and back. Through each incision, an average of 3-4 lipomas were removed. The incisions were made with a #10 blade and then carried down to the subcutaneous tissue. Using the cautery, dissection was then continued down to the capsule of the lipoma. The capsule was incised, delivering the lipoma with the intact capsule. The depth varied between 2 and 5 cm. Each time a lipoma was removed, additional numbers of lopoma would then surface and had to be removed through the same incisions. The maneuver was then carried out at each of the multiple incisions used in this case. Bleeding points were coagulated.
SuperCoder Answered Thu 04th of January, 2018 04:22:56 AM

Lipomas are a type of tumor which are usually benign and can be found in multiple locations. As per general guidelines, when the lipoma is present superficially, it would be appropriate to use an excision code from the integumentary system (11400-11446, Excision, benign lesion). However, when the lipoma is in a deep subcutaneous, subfascial, or submuscular location, an appropriate code from the musculoskeletal system (21930-21933, Excision, tumor, soft tissue of back or flank) should be billed.

When coding excisions, all simple wound repairs are included in the surgical package of the excision, and may not be reported separately.

When coding wound repairs, all excisions include a simple closure in the surgical package, and may not be billed separately. However, for excisions requiring more than a simple closure, one may report an intermediate (12031-12057) or complex (13100- 13160) repair, along with the excision code.

Wound repair codes should only be used when the surgeon uses staples, sutures, or tissue adhesives to close the wound. If the surgeon uses adhesive strips, the repair must be reported using an E/M code (99201-99499) instead. 

Hope this helps. Thank you.

Victoria Posted Thu 04th of January, 2018 16:05:16 PM
If the lipomas are subcutaneous,subfasial, or submuscular location and the physician removed approximately 50 lipomas how would that be billable?
SuperCoder Answered Sun 07th of January, 2018 13:34:48 PM

In such a case, each unit can be coded for the same incision and basis the number of incisions the physician can bill the number of units.

For subcutaneous, the codes that can be billed-21930/21931

For intramuscular/subfascial-21932/21933

Thank you.

 

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