OST-249 - Chapter 6 - Integumentary System (10000 series)

Repair of nail bed

11760 (Assigned as Nail, Repair, Nail Bed)

Which modifier would you use if a re-excision procedure is performed during the postoperative period of the primary excision of a malignant lesion?

-58 (Modifier -58 would be appropriate when a staged and/or related procedure is performed in the global/postoperative period.)

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

10060 (Incision and drainage was performed. Since the report does not state any further information, the least significant would be assigned, namely 10060.)

Incision/drainage of cyst

10060 (Incision and drainage was performed. Since the report does not state any further information, the least significant would be assigned, namely 10060.)

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 of foreign body from the skin would be assigned code 10120.)

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 (The total area of the surgical debridement would be coded. Since the total area has not been documented, would assume the least significant, which would be 20 sq cm or less.)

Debridement of bilateral heel decubiti down through muscle

11043 (Excisional debridement through muscle is assigned to 11043 (size not specified).)

A 25-year-old male is having debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer and eschar infection was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal.

11044 (Excisional debridement performed through bone is assigned 11044 (sq cm not specified).)

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

11056 (Lesions were curreted off only; therefore, paring/cutting code would be assigned.)

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

11106-59 (Would assign biopsy code 11106 with modifier -59 to indicate the biopsy was to a distinct, separate site from the malignant lesion removal. Note the question asks what code(s)would be appropriate for the biopsy only.)

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, 11106-59 (Shaving of lip lesion would be assigned 11310, biopsy of nasal lesion would be assigned 11100 with modifier 59 to indicate biopsy performed to a distinct, separate lesion.) WRONG

Excision lesion, 2.0 cm leg

11402 (Assigned as benign (as not stated as malignant), 2.0 leg; therefore, code 11402 is assigned.)

Skin lesion, right flank and back, possible melanoma in situ. Incisions made around lesions, allowing 0.5 cm border. Right flank lesion measured 1.5 cm, back 0.8 cm. Further dissection to margin borders was obtained and the specimens sent to pathology.

11403, 11402-51 (Possible melanoma cannot be assigned as malignant as "presumed" only. Flank lesion is 1.5 cm + 0.5 + 0.5 margins = 2.5 cm, code 11403. Back lesion measures 0.8 cm + 0.5 cm +.5 cm = 1.8 cm, code 11402-51. Modifier -51 is appended to multiple skin procedures performed during the same surgical session.)

Excision of benign lesion: 4.0 cm arm, 2.0 cm leg, and 2.0 cm back

11404, 11402-51, 11402-59 (Three lesions were excised; therefore, three codes are needed. Arm lesion largest, therefore, most significant, 11404; leg and back lesions are of same code, therefore, modifier -59 is assigned to the second 11402 code to indicate separate, distinct lesion. Append modifier -51 when multiple surgical procedures of the skin are performed during the same surgical session.) WRONG

Left nasal labial fold lesion was excised utilizing wide margins. Wound was closed. Patient also reported bilateral impacted cerumen prior to surgery with request to remove. After removal of lesion, an operating microscope was utilized to remove cerumen using a cerumen spoon.

11440, 69210-50 (Assign 11440 for nasal lesion excision. Per CPT, cerumen spoon is considered surgical instrument; therefore, 69210-50 would be appropriate.)

Excision of benign right forehead lesion. Right temple lesion was clearly evident, 1 x 1 cm, pigmented, mole-type lesion being excised due to sudden appearance. Area was cleaned, infiltrated with Xylocaine, and then excised completed and submitted to pathology.

11441 (Lesion is 1 cm, benign, face. Therefore, code 11441 would be appropriate.)

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.

11443, 15120 (Lesion only "presumed" malignant is, therefore, coded as benign. A 2.5 cm benign face codes to 11443. STSF codes to 15120.)

Excision, benign lesion, 4 cm cheek

11444 (Would be assigned code from the Excision Benign Lesions, cheek, 4 cm, code 11444) WRONG

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 (Coded as Excision Lesion Benign, Forehead, 4.5 cm, code 11446.)

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 of lesion codes is not appropriate in this instance, as there is a specific code for removal of hidradenitis (11450). Simple removal is assigned as the extent of the repair was not documented and, therefore, assumed to be simple.) WRONG

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, 11601-59 (Two malignant lesions of the same anatomical grouping were excised. Unlike repair/closures, these codes are NOT summed together but listed separately. Since they assign to the same code, 11601, modifier -59 is assigned to indicate these are two distinct lesions excised.) WRONG

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, 15220 (Excision of malignant lesion, 2 cm leg is assigned code 11602. Also FTSG was performed; therefore, 15220 would be appropriate (intended to be STSG).)

Re-excision of melanoma left arm with 1 cm margins. Dissection through the previous skin incision was made, down to fascia, and all underlying tissue was removed.

11602-58 (Re-excision would require use of modifier -58 in this scenario. Size was not specified; however, the margins totaled 2 cm. Therefore, 11602 would be appropriate. Melanoma is assumed to be malignant and re-excision is treated the same as original excision.) WRONG

Excision malignant lesion, 2.0 cm leg with 0.5 cm margins

11603 (Assigned malignant lesion, leg, 2.0 cm + margins (0.5 + 0.5) for a total of 3.0 cm. Therefore, code 11603 would be appropriate.) WRONG

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, 11604-51 (Two lesions were excised; therefore, two codes would be assigned. The lesions were specified as malignant. Code 11622 for the arm lesion (2.5 cm + 1.0 total margins = 3.5 cm), code 11622. Second lesion, scalp, 1.5 cm code, 11604-51. Modifier -51 is appropriate for multiple procedures on the skin during the same surgical session.)

Excision of malignant lesion, face, 2.0 cm

11642 (Coded as Excision Malignant Lesion, Face, 2.0 cm)

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

11642, 11403-51, 17282-51 (Excision lesions are assigned first, malignant is primary, code 11642 for 1.5 malignant face, followed by benign lesion 2.5 cm arm, code 11403-51, and then destruction lesion 17282-51.) WRONG

Excision of a 2.75 cm basal cell carcinoma of the left nare

11643 (Code located in Integumentary Section, Excision Malignant Lesion, nose, 2.75 cm. There was no split thickness skin graft performed, therefore, the other answers would not be appropriate in this instance.)

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

11643 (Coded as Excision Malignant Lesion, Face, 2.0 cm + 0.5 + 0.5 = 3.0 cm)

Excision of malignant lesion arm, 2.0; malignant lesion, face, 2.5 cm

11643, 11602-51 (Two codes are assigned: one for each lesion, 11643 for Excision Malignant Lesion, face, 2.5 cm; 11602-51 for Excision Malignant Lesion, arm 2.0 cm.)

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

11643, 15260 (Two codes are appropriate: one for the excision of the malignant lesion (11643) and the other for the FTSG (15260).

Morpheaform basal cell carcinoma of the nose. Incision was made along with marked areas, measuring 4 cm. Left preauricular incision was made and elliptical FTSG was taken and sutured into place.

11644, 15260 (Malignant lesion nose, 4 cm codes to 11644. Full thickness skin graft is coded to the recipient site, nose; therefore, 15260 would be appropriate.)

Diagnosis: Basal cell carcinoma (BCC), left chin. Procedure: Wide local excision of 3.0 cm with 0.3 cm margin BCC of the left chin with a 4 cm closure. A 15-blade scalpel was then used to make an incision in the previously marked site. The lesion was then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic orientation. The wound was then closed by advancing the tissue surrounding the lesion and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin.

11644, C44.319 (Diagnosed as basal cell carcinoma; therefore, dx code C44.319 and CPT code 11644 for Excision Malignant Lesion, chin, 3.6 cm (3.0 +0.3 + 0.3).)

A 55-year-old male presents in the office with an ingrown toenail on both feet. The right foot was prepped and draped in sterile fashion. The right great toe was anesthetized with 50/50 solution of 2% Lidocaine and 0.05% Marcaine. The lateral border was incised and excised in total. At this time, the patient elected to only have one performed and will return in 2 weeks for the left foot.

11750-T5 (Assign code 11750-T5 for right great toe.)

Patient presents to the ED with a 1 cm laceration of the scalp for repair. Area was prepped and draped and the wound cleansed. Skin closure was accomplished with the two sutures.

12001 (Assigned 1 cm repair/scalp as complexity not stated would assume simple.)

Repair, 2.3 cm arm, simple

12001 (Assigned simple, arm, less than 2.5 cm) WRONG

Laceration repair of a 2.5 cm wound of hand

12001 (Coded as simple, hand, 2.5 cm; therefore, code 12001 would be appropriate.)

Repair of laceration to the left ring finger

12001 (Smallest size and complexity should be utilized when not specified, therefore, coded to simple, < 2.5 cm, which codes to 12001.)

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 (Multiple lacerations in the same anatomical grouping should be added together and one code reported: 2 cm + 1 cm = 3 cm hand/arm, simple. Therefore, code 12002 should be assigned.) WRONG

Laceration repair, 2.0 cm, face

12011 (Assigned as Repair/Closure, Face, 2.0 cm)

A 78-year-old resident of nursing home presents for repair of 1.5 cm forehead laceration and skin tears on both hands. The forehead laceration was repaired but continue to ooze, so a pressure dressing was applied.

12011 (Only the forehead laceration was repaired. Stated as 1.5 cm, however, complexity was not specified and, therefore, would be assumed simple. Therefore, code 12011 would be assigned.)

Laceration repair, 1.5 cm face

12011 (Repair/closure, 1.5 cm face. Assumed simple complexity as not stated otherwise)

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

12014 (Assigned simple repair/closure as documentation does not state repair extended into deep subcutaneous.)

A patient presents for closure of 6.5 cm laceration to forehead. The wound was repaired in two layers and dressing was applied and the patient discharged.

12014 (Does not qualify for intermediate closure unless extended into the deep subcutaneous. Therefore, code 12014, simple, 6.5 cm face, would be assigned.)

Laceration repair: 2.0 cm arm, simple; 2.0 cm arm, simple; 3.0 cm leg, simple; and 2.0 cm leg, intermediate

12031, 12002-51 (Three of the lacerations are simple and in the same anatomical grouping; therefore, they are all added together to make 7 cm to arms/legs, code 12002-51, and 2.0 cm leg intermediate, code 12031. Intermediate repair would be considered most significant; therefore, 12031 would be assigned as the primary code.)

Repair of three lacerations as follows: Upper arm, deep subcutaneous layer closed with 4-0 Nylon, skin with 4-0 Vicryl. Second wound on the lower left arm required only skin closure. Third laceration on the lower leg required 4-0 Nylon for deep subcutaneous layer and 4-0 Nylon for skin repair measuring 2.8 cm.

12032, 12001-51 (Only size of third laceration was specified as 2.8 cm. All lacerations/closures of same complexity and same anatomical groupings are added together. Therefore, the upper arm laceration and lower leg would be added: 0 cm (size not specified) + 2.8 cm = 2.8 cm intermediate, arms/legs = 12032. Second wound of arm was simple only. Size was not indicated; therefore, 12001-51 would be assigned. Modifier -51 is appropriate for multiple procedures performed on the skin in the same surgical session.)

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 (Each repair/closure requires a separate code as different anatomical grouping and/or different complexity. Therefore, intermediate arm would be assigned first, as most significant, code 12032, followed by simple nose 2.0, code 12011-51, followed by simple arm 2.0 cm, code 12001-51.)

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 (Extensive cleaning was performed prior to repair. Therefore, per CPT, intermediate repair code would be utilized, smallest size (since size not stated).) WRONG

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 (When extensive cleaning prior to closure is documented, it qualifies for intermediate closure. Therefore, intermediate, finger, smallest size (size not stated), code 12041 would be appropriate.)

Laceration repairs as follows: face, 2.0 simple; face, 3.0 cm intermediate; hand 2.0 cm simple; and arm, 2.0 simple

12052, 12011-51, 12002-51 (Three codes are assigned, as two of the repairs/closures are of same complexity/anatomical grouping (arm and hand). Intermediate codes are assigned first, code 12052 face, 3 cm, then face, simple 12011-51, then hand/arm 4.0 cm simple 12002-51.)

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

14020 (Only adjacent tissue transfer is codable, therefore, assign 14020 for scalp. Per CPT guidelines, the excision of lesion when performed in conjunction with an adjacent tissue transfer is not separately codeable.)

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

14021 (Excision malignant lesion is included in adjacent tissue transfer, and, not separately coded. Assign code 14021 as transfer is 20 sq cm.)

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

14040 (Only adjacent tissue transfer is codable, therefore, assign 14040 for neck. Per CPT guidelines, excision of lesions when performed in conjunction with an adjacent tissue transfer is not separately codeable.)

Excision of a basal cell carcinoma of the right nose and reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect.

14060 (Only the advancement flap (adjacent tissue transfer) is assigned. Code 14060 would be appropriate as lesion is included.) WRONG

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

14060 (Only the rotation flap (adjacent tissue transfer) is assigned when performed in conjunction with excision of lesion. Therefore, 14060 only is assigned.)

A 1.3 cm nasal lesion excised from nasal labial area. Pedicle flap was elevated along the nasal labial area and rotated into position.

14060 (When adjacent tissue transfers are performed, lesions excised are not separately codable. Therefore, only 14060 would be appropriate in this instance.)

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 (When rotation flap (adjacent tissue transfer) is performed with excision of lesion, excision is not codable per CPT. Therefore, only 14060 would be reported in this scenario.) WRONG

STSG from thigh to arm, 2 x 3 cm

15100 (Split-thickness skin graft to arm (assign recipient site); size is calculated as 2 x 3 cm = 6 sq cm.)

Nonhealing wound on the tip of the nose. Documented an autologous split-thickness skin graft (STSG) to the tip of nose. A simple debridement of granulated tissues is completed prior to the placement. Using a dermatome, an STSG was harvested from the left thigh. The graft is placed onto the nose defect and secured with sutures. The donor site is examined, which confirms good hemostasis.

15120 (Coded to the split-thickness skin graft of the nose (recipient site). No additional codes are appropriate as debridement was not stated as excisional as required for preparation codes.)

FTSG, cheek, 3 x 5 cm

15240 (Full-thickness skin graft, cheek, size calculated as 15 cm (3 x 5 = 15 sq cm))

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

15822-50 (Superior eyelids would be the upper eyelids and blepharoplasty was performed. Despite the fact that stated fat pad excised, it does not indicate weighing down lid; therefore, 15822 would be appropriate. To report bilaterally, append modifier -50 to CPT code 15822.) WRONG

A 33-year-old male presents to have multiple lesions destroyed. Three benign lesions on her face are destroyed and five actinic keratoses on her left arm are destroyed.

17000, 17003 x 4, 17110 (The actinic keratosis would be assigned 17000 for the first lesion and 17003 for each additional lesion (total of four additional). 17110 would be assigned for the destruction of the benign lesions.)

In a 30-year-old patient, two actinic keratoses were removed by cryotherapy, each 0.5 cm in size. The physician also applied liquid nitrogen to a wart located on the left thumb.

17000, 17003, 17110-51 (Actinic keratoses are assigned codes in the 17000 series. Two were removed; therefore, 17000 would be assigned for the first lesion, and 17003 for the second lesion. The wart would be assigned 17110-51 as an additional procedure. 17003 does not need modifier -51 as it is designated as an "add-on procedure," which does not require modifier -51.)

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.

17280 (The tumor was ablated and vaporized; therefore, code 17280, destruction of malignant lesion, is appropriate.)

Patient has basal cell carcinoma on his upper back. Excisions 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.

17313, 17314, 17315 (Mohs surgery coded as 17313 for the first blocks, 17314 for each additional stage (1 additional), and 17315 for each additional block (one additional block).)

Needle biopsy, breast

19100 (Code located in the Integumentary Section, Breast, under Excision, Breast, biopsy, needle. Other code selections are for excision of the entire lesion or excision of breast (mastectomy).)

A 78-year-old female had recent mammographic and ultrasound abnormalities in the 6 o'clock position of the left breast. She underwent core biopsies, which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, a generous excisional biopsy was performed around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology.

19101-LT, N63.20 (Diagnosis would be breast mass only as no pathology has been received at the time of the coding assignment; therefore, N63.20 would be appropriate. Surgeon performed incisional biopsy only; therefore, 19101-LT only would be appropriate. Other procedures performed prior to surgical procedure.) WRONG

Excisional breast biopsy, right breast

19101-RT (Assigned from Integumentary, Breast, Excisional, biopsy, breast, code 19101 with modifier -RT to indicate right breast.) WRONG

Duct exploration and excision. Curvilinear incision was made, and the areolar flap was elevated until the ductal tissue was encountered. An enlarged blue-black looking duct was encountered, and it was circumferentially dissected. Then further excised ductal tissue off the back of the nipple. All was submitted for pathology.

19120 (Code 19120 includes "excision of duct lesions.")

Patient presented for excisional breast biopsy. Incision was made around the whole lesion and removed in toto. Lesion appeared to be approximately 2 cm in diameter.

19120 (Stated as excisional biopsy. However, report indicates that the entire lesion was removed. Therefore, for excision of breast lesion, code 19120 would be appropriate.)

Excision of breast lesion, 1.5 cm, left breast

19120-LT (Assigned as Excision breast lesion, LT)

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 (No mention of preoperative radiological marker; therefore, only the mass was removed, which is reported with 19120-LT. Codes 19101 and 19100 are for biopsy only, when only a portion of the mass/lesion are removed.)

When excision of breast lesion is performed with the placement of a marker, the surgery would be coded as

19125 (Assigned from Excision, breast, lesion, with preoperative radiological marker, code 19125.)

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

19125 (Code 19125 is assiged for excision of breast lesion identified with preoperative radiological marker.)

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

19125 (Excision of breast lesion/mass, identified by preoperative marker, is assigned 19125.)

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

19125-LT (Assign code 19125 for excision of breast lesion identified with preoperative radiological market. Modifier -LT would indicate left breast.)

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 (The placement of the localization device was performed by the radiologist and therefore not reportable by this physician. However, code 19125-RT would be assigned since a localization device was placed prior to excision.)

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 is assigned to 19300-LT.)

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.

19300-LT, 11200-59 (Mastectomy for gynecomastia is assigned to 19300. Also skin tag was excised by shaving, which codes to 11200. To indicate that the skin tag was excised from a distinct site, modifier -59 would be assigned.)

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 (Specified as mastectomy being performed for gynecomastia; therefore, code 19300-RT would be appropriate.) WRONG

Lumpectomy, right breast

19301-RT (Lumpectomy considered partial mastectomy is assigned code 19301-RT.)

Diagnosis: Ductal carcinoma in situ, left 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 (Partial breast was removed; therefore, mastectomy code is appropriate. Code 19301 is assigned for partial. RT is assigned for right breast.)

Two cc of Methylene blue dye was injected beneath the areola and incision was made along the axillary hairline for sentinel node biopsy. An enlarged deep node was identified and excised for biopsy. Next, an incision was made over the left lateral breast lump and a sharp dissection margin of normal tissue as well as the palpable lump was taken and excised completely. Sentinel node biopsy returned as positive, and complete deep axillary node dissection was performed.

19302-LT, 38900 (Partial mastectomy was performed with axillary lymphadectomy. Since the axillary dissection was completed, code 19302 (partial mastectomy with axillary lymphadectomy) would be assigned. In addition, code 38900 would be assigned for the injection of non-radioactive dye.)

Excisional biopsy of right breast with frozen section, followed by lumpectomy and axillary node dissection. Mass in the upper right breast was excised for biopsy. The pathology reported infiltrating ductal carcinoma. Elliptical incision was carried down to the pectoralis muscle; upper right breast quadrant was removed. Proceeded with axillary node dissection. Complete axillary node dissection was completed and submitted for pathology.

19302-RT (Initially biopsy performed, however, extended into lumpectomy with axillary node dissection, which codes to 19302-RT.)

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 (Partial mastectomy was performed (19301) with axillary lymphadenectomy. Since the dissection was completed, code 19302 (partial mastectomy with axillary lymphadectomy) would be assigned.)

Right subcutaneous mastectomy. Incision was made and areola was elevated off the breast tissue. Breast tissue was excised and removed.

19304-RT (Subcutaneous mastectomy is assigned code 19304-RT.) WRONG

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

19305-RT (Since mastectomy was performed to include a radical mastectomy and the pectoral muscles and axillary lymph nodes were excised, code 19305-RT would be the most appropriate choice. The other answer choices involve less than radical (such as 19301 and 19303) and more extensive (19306) than was documented.) WRONG

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 (Modified radical mastectomy was performed with axillary lymphadenectomy. Therefore, code 19307-RT would be appropriate.)

Replacement of deflated breast implant. Patient noted implant increasingly smaller and soft. A pinpoint hole on the posterior aspect of the implant was located. The new implant was inspected, prepared, and inserted using a no-touch technique and inflated with normal saline to 450 cc.

19325 (New breast augmentation with prosthetic (implant) performed. Removal of old prosthetic is included in new procedure.) WRONG

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 (Modifier -58 would be appropriate since this was a stage/related procedure. Code 19342 is the appropriate code for delayed insertion of the prosthesis.)

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 TRAM flap, which is performed uneventfully.

19367-RT (Reconstruction/repair by TRAM flap is assigned 19367-RT. If performed during the postoperative period, it would need modifier to reflect those circumstances.)

Incision was made through the deep subcutaneous tissue, removing the entire lesion located on the left chest wall. Following removal, the skin was closed in multiple layers.

21555 (Excision was made into the deep subcutaneous tissue; therefore, musculoskeletal code should be utilized. Code 21555 describes subcutaneous excision of lesion chest/thorax, smallest size since size not specified.)

A patient presents for a 2.5 cm excision of a left foot mass identified as a ganglion cyst on pathology with simple closure.

28090-LT (Mass extends into musculoskeletal tissue; therefore, codes from musculoskeletal section are assigned. Code 28090 is for excision of foot lesion. Simple closure is included in all procedures in the musculoskeletal section.)

Patient presents with right wrist pain from a fall from stairs. X-ray suggests a spiral radial fracture possible. Images will be sent to orthopedics for confirmation later.

M25.531, W10.9XXA (Cannot code "possible" or "suggest"; therefore, right wrist pain and external cause code only for scenario. Seventh digit for treatment period is NOT required for "pain" diagnosis.)

Multiple simple laceration repairs are performed on the right arm and leg. What modifier(s), if any, would be appropriate? None -59 -51 -51-RT

None (When multiple lacerations are repaired that are of the same complexity and anatomical grouping, they should be grouped together and summed together.) WRONG

Laceration, 2 cm, left eyebrow, extending into the dermis and subcutaneous tissue. Wound was closed with the placement of Steri-strips to the area. 12011 12013 12001 Office visit only

Office visit only (Per CPT, when repair/closure performed utilizing Steri-strips, does not qualify for repair/closure codes. Therefore, only an E/M office visit would be appropriate.)

A worried mother brought her child in to be cleared of any injuries following involvement in a motor vehicle accident earlier in the day. The child has no complaints; however, the physician decides to observe the patient for a few hours just to be sure.

Z04.1 (Observe suspect following transport accident codes to Z04.1.)

Laceration of hand requiring extensive cleaning, 2.5 cm none of these codes 12001 12006 12011

none of these codes (Repair with extensive cleaning, an intermediate repair code should be assigned. None of the codes listed are intermediate closures.)

Excision of benign lesion trunk, 2.7 cm with simple closure 1400 none of these codes 11402 11401, 1200

none of these codes (Would be assigned excision, benign, trunk, 2.7 cm, code 11403 that is not listed. Therefore, "none of these codes" would be appropriate.)

Laceration repairs completed with the use of Dermabond rather than sutures would be coded as

simple laceration repair. (Dermabond is considered surgical repair/closure; therefore, the appropriate repair/closure code would be assigned.)