Lesions, and Masses, andTd Tumors – Oh M !!Oh …

1 1 Lesions, and masses , dTOh M !!and Tumors Oh My!!Presented by:Betty Johnson, CPC, CPC-I, CCS-P, PCS, CPC-H, RMC, CCP, CIC, CPCDd1andSusan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC1 Agenda CPT GUIDELINES CPT DEFINITIONS OP REPORT CASES22 Definitions Cyst - a closed sac having a distinct membrane and developing abnormally in a cavity or structure of thedeveloping abnormally in a cavity or structure of the body Dermatofibroma - a benign, chiefly fibroblastic nodule of the skin found especially on the extremities of adults Lipoma - a tumor of fatty tissue 3 Neoplasm - a new growth of tissue serving no physiological function Diagnosis Codes Malignant Primaryy Secondary In Situ Benign Uncertain Behavior4 Ucetaea o Unspecified Behavior3 Diagnosis Codes Mass Painful?

2 tumor Pathology Report Cyst Type5 Melanoma Melanoma InSituANATOMY647 The rectus sheath, an example of a fascia85 CPT Musculoskeletal2010 Changes To 20000 Code Set 41new codes41 new codes 53 revised codes 7 deleted codes9 New guidelines for soft tissue and bone tumorsCPT MusculoskeletalExcision of subcutaneous soft tissue Tumors Simple & Intermediate repair bundled Confined to subcutaneous tissue below the skin, butabove the deep fascia Usually benign Code selection based on location and size of tumor10 Size determined by greatest diameter of tumor plusmost narrow margin necessary for excision6 CPT MusculoskeletalExcision of fascial or subfascial soft tissue Tumors Simple & Intermediate repair bundled Confined to the tissue within or below the deep fascia.

3 But notinvolving the bone Usually benign and often intramuscular Codeselectionbasedonlocationandsizeoftum or11 Codeselectionbasedonlocationandsizeoftum or Size determined by greatest diameter of tumor plus mostnarrow margin necessary for excisionCPT MusculoskeletalRadical resection of soft tissue Tumors Simple & Intermediate repair bundled Involves resection of tumor with wide margins ofnormal tissue Maybeconfinedtoaspecificlayermayinvolve1 2 Maybeconfinedtoaspecificlayer.

4 Mayinvolveremoval of tissue from one or more layers7 CPT MusculoskeletalRadical resection of soft tissue Tumors Most common for malignant Tumors or veryaggressive benign Tumors Code selection based on location and size oftumor13 Size determined by greatest diameter of tumorplus most narrow margin necessary for excisionCPT MusculoskeletalRadical resection of bone Tumors Simple & Intermediate repair bundledSimple & Intermediate repair bundled Involves resection of tumor with wide margins of normal tissue May require removal of entire bone if tumor growth is extensive14is extensive Most common for malignant Tumors or very aggressive benign tumors8 CPT MusculoskeletalRadical resection of bone tumorsIfdift tiid d ith If surrounding soft tissue is removed during these procedures, radical resection of soft tissue tumor codes should not be reported separately (bundled)

5 Code selection based on location of tumor , NOT size or whether tumor is benign, malignant, primary, or 15metastaticCPT Musculoskeletal21011 Excision, tumor , soft tissue of face or scalp, subcutaneous; less than2cmsubcutaneous; less than 2 cm210122 cm or greater21013 Excision, tumor , soft tissue of face or scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm210142cmor greater1621014 2 cm or greater21016 Radical resection of tumor , soft tissue of face or scalp, 2 cm or greater9 CPT MusculoskeletaL21555 Soft tissue, subcutaneous, neck/anterior thoraxless than 3cm#215523cm or greater21556 Soft tissue, subfascial, neck/anterior thorax lessthan 5cm# 215545cm or greater1721557 Radical resection soft tissue neck/anterior thoraxless than 5cm215585cm or greaterCPT Musculoskeletal21930 Soft tissue back/flank.

6 Subcutaneous less than 3 cmcm219313 cm or greater21932 Soft tissue back/flank, subfascial less than 5 cm219335 cm or greater1821935 Radical resection soft tissue back/flank less than 5 cm219365 cm or greater10 CPT Musculoskeletal22900 Soft tissue abdominal wall, subfascial less than 5 cmcm229015 cm or greater22902 Soft tissue abdominal wall, subcutaneous less 3 cm229033 cm or greater22904 Radicalresection soft tissue abdominal wall less1922904 Radical resection soft tissue abdominal wall less than 5 cm229055 cm or greaterCPT Musculoskeletal23075 Soft tissue shoulder area, subcutaneous less than 3cm3 cm230713 cm or greater23076 Soft tissue shoulder area.

7 Subfascial less than 5 cm#230735 cm or greater2023077 Radical resection soft tissue shoulder area less than 5 cm230785 cm or greater11 CPT Musculoskeletal24075 Soft tissue upper arm/elbow area subcutaneous less than 3 cm#240713 cm or greater24076 Soft tissue upper arm/elbow area subfascial less than 5 cm#240735 cm or greater2124077 Radical resection soft tissue upper arm/elbow area less than 5 cm#240795 cm or greaterCPT Musculoskeletal25075 Soft tissue forearm/wrist area subcutaneous less than3cmthan 3 cm#250713 cm or greater25076 Soft tissue forearm/wrist area subfascial less than 3 cm#250733 cm or greater2225077 Radical resection soft tissue forearm/wrist area less than 3 cm250783 cm or greater12 CPT Musculoskeletal26115 Soft tissue hand/finger subcutaneous less than cmcm# cm or greater26116 Soft tissue hand/finger subfascial less than cm# or greater2326117 Radical resection soft tissue hand/finger less than 3 cm261183 cm or greaterCPT

8 Musculoskeletal27047 Soft tissue pelvis/hip area subcutaneous less than 3cm3 cm#270433 cm or greater27048 Soft tissue pelvis/hip area subfascial less than 5 cm#270455 cm or greater2427049 Radical resection soft tissue pelvis/hip area less than 5 cm#270595 cm or greater13 CPT Musculoskeletal27327 Soft tissue thigh/knee area subcutaneous less than3cmthan 3 cm#273373 cm or greater27328 Soft tissue thigh/knee area subfascial less than 5 cm#273395 cm or greater25#27329 Radical resection soft tissue thigh/knee area less than 5 cm273645 cm or greaterCPT Musculoskeletal27615 Radical resection soft tissue leg/ankle less than 5 cmcm276166 cm or greater27618 Soft tissue leg/ankle subcutaneous less than 3 cm#276323 cm or greater2627619 Soft tissue leg/ankle subfascial less than 5 cm#276345 cm or greater14 CPT Musculoskeletal28043 Soft tissue foot/toe subcutaneous less than cm#2803915cmor greater# cm or greater28045 Soft tissue foot/toe subfascial less than cm# cm or

9 Greater28046 Radicalresection soft tissue foot/toe less than32728046 Radical resection soft tissue foot/toe less than 3 cm280473 cm or greaterCoding Op ReportsCODING MUSTSTlil? tumor , mass, lesion , or else? Depth (subcutaneous, subfascial, bone) Size28 Watch for the out of sequence codes15 PROCEDURE PERFORMED: Excision mass, behind right ear with excised diameter of 8 mm and complex repair cm I incised the ellipses I drawn it and then dissected down to the mass which was found deep to the superficial fascia of her neck.

10 It appeared to be a small lipoma or possibly a lymph node. Hemostasis achieved using th B itIbl tthl t l D f tthe Bovie cautery. I was able to remove the mass completely. Defects were created at each end of the wound to optimize the primary repair because thus I considered a complex repair. The wound was closed in layers using 4-0 Monocryl and 5-0 Prolene. Loupe magnification was used. The patient tolerated the procedure Report: Inflam