Excision of Lesions Surgical ApproachSurgical …

1 1 Excision of Lesions Surgical ApproachSurgical ApproachAll Rights Reserved1 Brenda Chidester-Palmer CPC, CPC-I, CEMC, CASCC, CCS-PObjectives In this session we will discuss lesion categories Removal versus biopsy Different lesion removal techniquesApproach for Excision of lesionsAll Rights Reserved2 Approach for Excision of Lesions Correct Diagnosis Coding2 lesion Categories Skin tag Wart plantar, common, viral lesion benign, malignant, uncertain Mass or LumpCystAll Rights Reserved3 Cyst TumorCoding Choices We base our code selection on a number of factors Removal or biopsy Type of lesion Benign or MalignantAll Rights Reserved4gg Cyst or Tumor Location of lesion Size3 What are we actually doing?

2 BiopsyRemovalwe are only taking a piece or sample of the lesion or growth to have we are removing the lesion in toto. This does not mean we will not All Rights Reserved5pathology tell us what the lesion out for Biopsy CPT codes 11100-11101 are for biopsy procedures. All Rights Reserved64 Shave Biopsy This can be confusing terminology when diA h i idt thcoding. A physician may document they performed a shave biopsy but there is not a corresponding CPT with this exact verbiage. Our choices areAll Rights Reserved7 Our choices are the 11100-11001 biopsy codes the 11300-11313 shave Excision codes Shave Biopsy, cont.

3 To correctly code for these services, we tkdtdhtthmust make sure we understand what the physician meant by shave biopsy. Some are actually doing the shave Excision and some just a biopsy. Careful review of the documentation and/or query or the All Rights Reserved8physician is necessary for correct Other CodesThere are other biopsy codes throughout the bti btthtfsurgery subsections but, these are not for biopsy of Lesions :20200 Biopsy of muscle, superficial20205 Biopsy of muscle, deep40409 Biopsy of lipAll Rights Reserved940409 Biopsy of lip40408 Biopsy of vestibule of mouth50200 Renal biopsy, percutaneousDifferent lesion Removal TechniquesThere can be several definitions to the term remove that physicians use for cysts, masses, Lesions , or Rights Reserved106 Ligature StrangulationUsed on skin Physician uses suture material.

4 Loops the suture material into a circle, places the circle over the pedicle, All Rights Reserved11pulls tight and yanks off. Ligature Strangulation, cont. Correct CPT codes for this type of lth 11200d 11201 Thi iremoval are the 11200 and 11201. This is not the only type of removal for this code set. These codes are specific to skin tag removal and are for any method includingAll Rights Reserved12removal and are for any method including chemical destruction, electrosurgical destruction, or any combination of or CuttingThis technique is used for benign hyperkeratotic skin Lesions such as cornshyperkeratotic skin Lesions such as corns or calluses.

5 CPT codes are 11055-11057 All Rights Reserved13 For paring a curette, blade or similar sharp instrument is Excision Shaving is not a full thickness dermal removal. It involves a transverse incision or horizontal lesion just to level ofAll Rights Reserved14 Removes lesion just to level of Excision Code selection is based on anatomic location and size Size range is: < cm to cm or > 11300-11303 Trunk, arms, or legs 11305-11308 Scalp, neck, hands, feet, All Rights Reserved15genitalia 11310-11313 Face, eyelids, nose, lips, mucous membranesDestruction of lesionsDestruction can be performed via.

6 P Cyrosurgery Chemosurgery ElectrosurgeryLAll Rights Reserved16 Laser surgery Surgical curettage9 Curettage Removal with a curette of a plantersRemoval with a curette of a planters wart on the sole of the footAll Rights Reserved17 Chemical DestructionChemicals are applied directly to a lesion to dt Thlidithb hdestroy. They are applied with a brush or cotton swab or injected into the chemicals used are:Liquid nitrogen (LN2)Trichloracetic acidAll Rights Reserved18 Trichloracetic acidCantharidin (on warts)Salicylic acid10 Chemical Destruction, for the following.

7 Skin tags Warts Benign lesionsAll Rights Reserved19 Malignant lesionsCryosurgery DestructionExamples of how chemicals can be application freezes the Rights Reserved2011 Electrosurgical DestructionWhen we use the term electrosurgical, we are using a general term thatare using a general term that encompasses the different procedures used to employ electrically generated Rights Reserved21 Electrosurgical DestructionTissue destruction by electro-surgery is the lt f th f llif tresult of the following factors.

8 Ohmic Heat Convective Heat Mechanical EnergyAll Rights Reserved2212 Electrosurgical Destruction Electrofulguration Electrodessication Does not touch lesion Distance of 2-3 mmShort bursts (23 lesion touched with electrode Bursts are longer (2-4 sec)Current intensityAll Rights Reserved23 Short bursts (2-3 sec) Current intensity slightly increasedElectrosurgical Destruction Electrocoagulation Electrosection Deeper tissue destruction lesion may not be touchedHigh current Cuts tissue Solid state current Simultaneous hemostasisAll Rights Reserved24 High current Deep necrosishemostasis Delayed healing13 Laser SurgeryLasers can be used to destroy Lesions or warts.)

9 Laser beam is directed at the preferred method of removalAll Rights CodesCoding for destruction of Lesions is not bdthth d f d ttibased on the method of destruction (chemosurgery versus Surgical curettage).It is based on the TYPE of lesion we are destroying and how MANY we areAll Rights Reserved26are destroying and how MANY we are destroying and LOCATION of the lesion (s).14 Destruction Codes Under the subheading of Destruction there are 2 categories Destruction, Benign or Premalignant Lesions Destruction Malignant Lesions AnyAll Rights Reserved27 Destruction, Malignant Lesions , AnyDestruction Codes Benign/Other 1700017004 premalignant Lesions (AK s) 17000-17004 pre-malignant Lesions (AK s)

10 17106-17108 cutaneous vascular proliferative Lesions 17110-17111 benign Lesions other than skin tags or cutaneous vascular Lesions All Rights Reserved28sags o cu a eous ascu a es o s 17250 chemical destruction granulated tissue15 Destruction Codes Malignant 17260-17266 Trunk, arms or legs 17270-17276 Scalp, neck hands, feet, genitalia 17280-17286 Face, ears, eyelids, nose lips, mucos membraneAll Rights Reserved29 Destruction CodesDestruction codes can be found in other SStibidthSurgery Sections besides the Integumentary codes are specific for Lesions in certain anatomical sites.