1 Series

Integumentary system
1. Incision & drainage (I & D)

Incis -> to cut

Drainage -> removal of fluid or collection of fluid

I & D = 10060, 10061

= 10060 (simple)

= 10061 (complicated or multiple)–

Coding points:

 For what kind of disease I & D is performed

10061

 I & D is performed multiple sites on same session

 I & D performed with packing
 Drain tube placement
 break up locations

I&D
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1. Patient is having leg abscess (superficial) came to hospital md performed Incised & expressed pus
collected.

2. Excision of pilonidal cyst simple:

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2. Destruction

 Destruction means ablation of benign, premalignant or malignant tissues by any method, with
or without curettment, including local anesthesia and not usually requesting closure

Cryosurgery

 Using low temperature (cold) used to destruct the cells with the help of liquid nitrogen

Cryopreservation

 Cells are stored in low temperature with the help of liquid nitrogen
{While we are coding we have to look the lesion is benign or malignant or pre malignant lesion}

Destruction Premalignant lesion (actinic keratosis) 17000-17004

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1. 11 AK lesions destructed by cryo surgery?

2. 15 AK lesions destructed by cryo surgery?

3. 7 AK lesions destructed by cryo surgery?

Benign lesion (17110-17111)

 Condylomata
 Papillomata
 Molluscum contagiosum
 Herpetic lesions
 Warts (common, plantar, flat)
 Milia

Destruction: Benign lesions

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1. 7 AK destructed by cryo surgery?

2. 17 plantar warts removed by cryo surgery?

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Destruction: Malignant lesions: (17260-17286)

Any lesion names ended with oma means that lesions are malignant lesions

 Which anatomical site

 How much diameter
 How many lesions destructed
 = Each lesions have to code separately
= don’t add the “cm” if it is falling same anatomical group
= tot 3 set of anatomical group

4 melanoma lesion present in Scalp 1 cm, 2 cm, 3 cm, 4 cm DESTRCUTED BY CRYO??

Answer:
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3. Removal of Skin Tags

11200 -> removal of skin tags, multiple fibro cutaneous tags, any area; up to and including 15 lesions

+11201 -> each additional 10 lesions or part there of (list separately in addition to code for primary
procedure)

1. 36 skin tags removed by sharp method?

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Repair / closure / suture: (All are same meaning)

Coding points:

 Look at site of the laceration wound

 Length of the laceration/open wound
 What suture material used for repair
 What type of repair

Types
Simple
Intermediate
Complex

Simple Repair

 Single layer + single wire = simple repair

 Single layer it can be either epidermis or dermis or subcutaneous without significant
involvement of deeper structures and requires simple one layer closure.
 Local anesthesia, chemical or electro cauterization of wounds is and all included so no need
code anesthesia or cauterization codes.

Skin Layers

 Epidermis
 Dermis
 Subcutaneous
{One layer involved + used one suture material means simple repair}
Anatomical groups 12001-12021

 If same anatomical group add the “cm” s and give only one code
 If different anatomical groups code each group separately.

Intermediate repair:

 Double layer + double wire = Intermediate

 If layered repair mentioned means code it as intermediate
 Single layer closure with removal of foreign body
 Single repair + heavily contaminated wounds requiring extensive cleaning
 Here 3 anatomical groups

Complex repair

Complex repairs (13100-13153)

 Multiple layer + multiple closure = complex repair
 Double layered + removal of foreign body
 Reconstructive procedures, complicated wound closure. Some of lengths of repairs for each
group of anatomic sites
 It includes the repair of wounds requiring more than layered closure, viz, scar revision,
debridement (e.g) traumatic lacerations or avulsions, extensive undermining, stents or retention
sutures. Necessary preparations includes creation of a limited defect for repairs or the
debridement of complicated lacerations or avulsions.

Laceration repairs closed with

 Adhesive strips -> (non codable)

 Tissue adhesive -> (codable)
 Adhesive strips + other material (tissue adhesive) = codable
 Steristrips = (non codable)
 Suture= codable
 Staples= codable

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Excision of Lesion

Coding points

 Check the lesion is whether benign or malignant

Benign malignant

Neoplasm Any lesion which comes with the suffix

“oma”
Cicatricial

Fibrous

Inflammatory

Congenital

Cystic lesion

Unspecified lesion

 We have to look location

 Excision diameter of the lesion
 Excised diameter = Lesion diameter+ 2(MARGIN)
11400- 11471
Excised diameter of the lesion = clinical diameter of apparent lesion + 2 x margin
3. Excised diameter of the lesion=Lesion dm+2(margin)

Notes

 Simple repair is included in excision of lesion

 Whereas intermediate and complex repair should be reported separately if performed

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Adjacent Tissue Transfer or Rearrangement: 14000- 14350

Another name for adjacent tissue transfer:

Z – Plasty

W – Plasty

 V-Y-> plasty
  Rotation flap
 Random island flap
 Advancement flap

Coding Points

 First we have to look location

 Area of ATT = Area of primary defect + area of secondary defect

 The area where the lesion is excised called primary area or primary defect
 The area damaged by physician called secondary area or secondary defect

Notes

 Simple repair, excision of lesion is included in ATT

 Simple repair + excision of lesion + ATT = ATT

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Fine Needle Aspirations:

 Using small needle to aspirate pus or fluid

FNA

 Biopsy is performed when material is aspirated with fine needle and the cells are examined
cytological.

FNA

Without images guidance

With image guidance
(10021 -> 1st lesion) +
10004 -> each additional 1. US -> 10005 1st + 10006 (each additional)
lesion Do not report 76942 with 10006 codes
2. Fluoroscopy guidance 10007 -> 1st + 10008 (each
additional)
Do not report 77002 with 10008 codes
3. CT guidance 10009 1st + 10010 (each additional)
4. MRI 10011 1st + 10012 (each additional)

1. FNA for 5 lesion without guidance?

2. FNA for 5 lesion with US guidance?

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 Biopsy

Biopsy included in Excision, Shave removals, destruction

Severity

Tangential biopsy – 11102, +11103 Incision

Punch biopsy - 11104, +11105 Punch
Incision biopsy - 11106, +11107 Tangential

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Breast procedure

1. Incision
2. Excision
3. Repair (or) introduction
4. Repair & reconstruction
5. Mastectomy

Incision

Puncture aspiration:

Puncture: they will use large needle

Puncture aspiration of cyst (4) of breast

Puncture aspiration of cyst in right and left breast

Breast

Breast biopsy without image Breast biopsy + Breast localization Breast localization Device + image
guidance guidance
Device + Image guidance
Percutaneous -> 19100 19281, + 19282 (mammography)
Stereotactic -> 19081, + 19082
Open incisional -> 19101 19283, + 19284 (Stereotactic)
US -> 19083, + 19084
19285, + 19286 (US)
MRI -> 19085, + 19086
19287, + 19288 (MRI)
Breast Localization Device

Small devices (e.g.) (clip, wire, slash needle, metallic pellet) used to mark the location of the breast
abnormality to make it easier for the provider to find the target area during biopsy

Mastectomy procedure in female

Partial – 19301

Simple or complete – 19303

Radical – 19305

Urban type – 19306

Modified radical – 19307

Pexy – Fixation

Repair or reconstruction

Reduction – they are reducing the size of the breast

Mammoplasty – augmentation – increasing the size of the breast with or without prostate implant

19380 – Revision of reconstructed breast

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Mohs Surgery
Mohs micrographic surgery is a technique for the removal of complex or ill – defined skin cancer with
histologic examination of 100% of the surgical margins

Stage: Tissue layers of the cancerous lesion

Block – small pieces of tissue samples

Tissue samples of the lesions

Stage codes

17311 + 17312 – Mohs surgery initial stage and each additional stage – head, neck, hands, feet, genitalia
or any location

17313 + 17314 - Mohs surgery initial stage and each additional stage trunk, arms, legs

+17315-Each additional extra blocks after initial 5 blocks

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Skin Graft

Auto Graft

The graft of tissue from one place to another place of the same individuals’ body

Allograft

A tissue graft from a donor of the same species as the recipient but not genetically identical

Xenograft

A tissue graft or organ transplant from a donor of a different species from the recipient

Coding points

 First we have to look type of graft

 Location
 Square cm
 Any additional procedure(e.g.) surgical preparation

Harvest of skin – 15040

Pinch graft – 15050

Split thickness – 15100, + 15101, 15120, +15121

Epidermal auto graft – 15110, 15111, 15115, 15116

Dermal Auto graft-15130, 15131, 15135, 15136

Tissue cultured Skin graft– 15150-15157

Full thickness auto graft -15200-15261

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Debridement

Depth of tissue that is removed and by surface area of the wound

Coding points

 For what kind of disease/injury debridement is performed

 Depth of the debridement
 Area of debridement

Types of debridement

 Extensive eczematous or infected skin 11000, + 11001

 Necrotizing soft tissue infection11004-11008
 Open fracture and open dislocation 11010- 11012
 WOUND (normal tissue) 11042- 11047
  For debride of epidermis / dermis 97597, + 97598
 Burn 16020, 16025, 16030

Depths

 Subcutaneous
 Muscle/fascia
 Bone

Note:

If multiple wounds debrided depth of the multiple wounds are same =we have to add together
and give only one code

If multiple wounds debrided depth of the multiple wounds are different =code each depth
separately.

Please write as per below order

1. I&D
2. Pilonidal cyst
3. Debridement
4. Destruction
5. Repair
6. Excision concepts (Benign, Malignant)
7. ATT
8. Mohs Surgery
9. Skin graft
10. Breast procedures
11. FNA
12. BIOPSY