Medical Billing Coding - Lipoma and Complex Closure, cpt, codes
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Thread Topic: Lipoma and Complex Closure
Topic Originator: Tiffany
Post Date September 29, 2016 @ 3:34 AM
Lipoma and Complex Closure

September 29, 2016 @ 3:34 AM Reply  |  Email Friend   |  |Print  |  Top

Hi everyone I am currently trying to understand how to code these two cases.

The First one is Excision of Lipoma:

1. Excision of 7-cm left neck lipoma
2. Excision of 4-cm lipoma, right upper arm
3. Excision of 3-cm lipoma, right upper arm

Dissection was carried down to subcutaneous tissues. (for left neck lipoma)
We then closed the subcutaneous tissues with 3-0 undyed vicryl and the skin with subticular 4-0 undyed vicryl.

An incision was made over the top of each and they were dissected free sharply. (for the two in the arm)

Pathology Report - Benign Lipoma of the soft tissues of the neck and right arm.

For this I keep thinking: CPT: 24071-RT, 24071-RT-59, 21552-59 and ICD-10-CM: D17.21, D17.0
But I think I keep missing something, anything can help thank you.

The Second Case is a Complex wound closure of the groin area

Post op DX: Right Groin Wound

Procedure Performed: Debridement and complex closure of left groin wound, a total of 29 cm.

Patient presented to the hospital a week ago with necrotizing fasciitis of the left groin. It was debrided multiple times. She has been on V.A.C. for 5 days. The wound is now clean and ready for closure.

The wound inspection showed a granulating bed with no evidence of necrotic tissue. The wound margins were excised approximately 1 to 2 mm off each margin. The remaining granulating base was then debrided with vigorous curettage using a large curet. The wound was then irrigated with 3 liters of saline using a pulse lavage irrigator. A drain was placed and brought out through a seperate stab wound incision superiorly and sutured into position. The deep tissues and fascia were reapproximated with a suture. The dermis was reapproximated with a suture. The epidermis was reapproximated with a suture.

I think it should be coded with a complex repair code. But Im not sure if there should also be a debridement code, since the debridement seems pretty extensive. Also that they cut out more margins makes me wonder if those need to be added to the total of the wound, but Im not sure since it says that is the total. Also I dont know if I need to do anything with the drain? I also cannot even figure out what the diagnosis (DX) is suppose to be. I know it isn't open wound of groin, and it isn't the fasciitis either. Also the fact that it begins as a right groin wound and then they say left, is really confusing. There is no one I can ask for clarification either. Also if it is a complex repair of soft tissues, where is groin area? Is it leg or trunk? Everything I have looked up says its basically the end of the abdomen (trunk) and the begining of the leg. Complex closures have separate codes for trunk and leg. I really need some help with this.

Again any help is appreciated thank you.

September 29, 2016 @ 3:47 AM Reply  |  Email Friend   |  |Print  |  Top

Please any help is appreciated.

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