Regarding deep dermis/skin closure. Would this ever be considered layered when deep subcu not mentioned? Also,
since this was a mass but not a tumor, would this be totally integumentary (11406) instead of a musculoskeletal code (tibial muscle was mentioned)?
Based on path, would the diagnosis code 709.3 or 782.2?
Preop/Postop Diagnosis: Left Leg Mass (Suspect Gouty Tophaceous Deposit)
Path: Polarizable crystal deposits consistent with gout
The skin was incised sharply and then skin sharply dissected off the
underlying mass which was immediately apparent after penetrating the
deep dermis. The mass was multilobulated with rock-hard induration
in many places. Sharp dissection technique was used to get around the mass and develop a plan between it and the underlying tibial
musculature. The deep dermis as then approximated with buried
interrupted sutures of 2-0 Vicryl and the skin closed with simple
interrupted sutures of 4-0 nylon.