Advertisement Upgrade to remove ads

How is the Integumentary System subsection formatted?

Anatomic site and category of procedure

Incision and Drainage codes are divided according to what?

First according to the condition for which it is being performed, and then by whether the procedure is simple or complicated.

Puncture Aspiration

Insertion of a needle into a lesion and withdrawal of the fluid inside.

True of False: All Incision and Drainage codes may be found within the Integumentary Subsection?

False. Use the index to find first the condition, then the location to determine where the most specific code is located.

When coding an abscess, when do you use the subterm "Skin"?

Only when there is no more specific location provided.

Debridement

Removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound.

Sharp and blunt dissection, curettement, scrubbing, and forceful irrigation are all examples of what procedure?

Debridement

Are debridement codes applied to burn treatments?

No. For debridement of burned surfaces, use CPT 16000-16036.

What two factors are used to determine coding of wound debridement?

Depth of tissue removed and surface area of wound.

How do you calculate depth for multiple wound debridements?

Code each depth separately (do not sum.)

How do you calculate surface area for multiple wound debridements?

Sum the surface area of all wounds at the same depth.

What modifier is used when reporting multiple wound debridements of different depths?

-59 (Distinct Procedural Service)

Is debridement included as part of the surgical package or is it coded separately?

It depends on the surgical procedure. Code debridement only when it is greater than that included in the surgical package.

Do debridement codes include some E/M service, or must the E/M service always be reported separately?

Debridement includes E/M. Only report if E/M service is separately identifiable (modifier -25).

Local infiltration, metacarpal/digital block, or topical anesthesia are/are not included in the reimbursement for debridement services,

They are included. They are not separately payable.

Paring, shaving, excision, and destruction are types of what kind of treatment?

Lesion destruction.

Ablation

Destruction

flat are of color change; no elevation or depression

macule

solid elevation; less than 0.5cm diameter

papule

solid elevation 05.-1.0cm diameter; extends deeper into dermis than papule

nodule

solid mass larger than 1cm

tumor

flat elevated surface found where papules, nodules, or tumors cluster

plaque

type of plaque; result is transient edema in dermis

wheal

small blister; fluid within or under epidermis

vesicle

larger blister; greater than 0.5cm

bulla

flakes of cornified skin layer

scales

dried exudate on skin

crust

cracks in skin

fissure

loss of epidermis that does not extend into dermis

erosion

area of destruction on entire epidermis

ulcer

excess collagen production following injury

scar

loss of some portion of the skin

atrophy

What elements are required to properly code lesion excision and destruction?

site, number, and size of excised lesions, as well as whether lesion is malignant and benign

If multiple lesions are being treated, how do you determine the order of coding?

Code the most complex lesion procedure first followed by the others using modifier -51 (multiple procedures performed).

If the code description includes multiple lesions, is modifier -51 necessary?

no

Simple closure

nonlayered closure (included in the codes for lesion excision).

intermediate closure

layered closure (code separately per notes)

complex closure

greater than layered closure (code separately per notes)

histopathology

study of microscopic tissue changes

What modifier cannot be used with skin tag codes?

-51 (Multiple Procedures). Codes are based on the number of lesions removed.

If simple closure is included in a code but an intermediate/complex closure is performed, how is the closure coded?

Add-on closure code from the Repair subheading (2031-13160)

hidradenitis

chronic abscessing and subsequent infection of a sweat gland

Avulsion

Surgical separation and removal of the nail plate to preserve the root so the nail will grow back (11730, 11732).

Onychocryptosis

ingrown toenail

What are examples of the Introduction category of Integumentary codes?

Lesion injection, tattooing, tissue expansion, contraceptive capsule insertion/removal, and hormone implantation services.

What is reported in addition to the introduction of the implantable contraceptive capsule?

Contraceptive supply code (J7306 or J7307)

What size pilonidal cyst is not considered complicated?

2cm or under

Lesion injections are located in the ________ category.

Introduction

What three factors must be considered when reporting wound repair?

Length of wound, complexity of repair, and site of repair

True or False: You can report intermediate closure (12031 - 12057) when the wound has to be extensively cleaned, even if the closure was a signle-layer (simple) closure.

True.

For multiple wound closures, how are codes calculated/totaled?

Add together lengths of wounds if they match in both complexity and anatomic site.

For multiple complexities of wound closures, how are codes listed?

List the most complex type first; list secondary procedures with modifier -51 (Multiple procedures)

full thickness graft

graft of the epidermis and all of the dermis

split thickness graft

graft of the epidermis and some of the dermis

In this kind of graft, some skin is left attached to the blood supply to keep the flap viable.

"Flap" graft

To correctly code a graft, what information is needed?

Type of graft
Donor site
Recipient site

Z-plasty, W-plasty, V-Y-plasty, and rotation flaps are examples of what?

Adjacent Tissue Transfers

According to the Rule of Nines, what percentages constitute a small, medium, and large burn?

A small burn is up to 4.5%, a medium burn is 4.5% to 9%, and a large burn is greater than 9%.

For what is the Lund-Brower Chart used?

To calculate the percentage of body surface involved in the burns of children.

True or False: use codes from the Debridement subheading to code burn debridement.

False. Code from the Burns subsection.

Which subheading of codes has a higher value- excision or repair?

Repair codes have a higher value than excision codes.

3 elements considered components of wound repair

Ligation, exploration, debridement (normal)

moving a segment of skin from one area to an adjacent area while leaving at least one side of the flap intact to retain some measure of blood supply to the graft.

adjacent tissue transfer

Adjacent tissue transfers are coded according to what measurement?

The size in square cm of the recipient site.

How is repair of the donor site of a graft or tissue transfer coded?

Simple repair is included in tissue transfer code. Complex closure or grafting of donor site is reported separately.

How are Adjacent Tissue Transfer or Rearrangement codes divided in the CPT manual?

Location and size of defect.

When skin grafting is required to cover both the primary and secondary defect, how is code selection determined?

Sum of measurements of both defects.

Abbreviation and synonym for split-thickness repair

STSG, or pinch graft

FTSG

Full thickness skin graft

Autograft

graft taken from patient's body

allograft

graft taken from a human donor

homograft

graft taken from a human donor

On what elements are dermal and epidermal grafts reported?

Graft depth, location, and size

acellular dermal replacement

use of skin replacement products based on the location and size of repair

tissue cultured skin autografts

grafts cultured from patient's own skin cells

What is the purpose of temporary allografts?

to protect defect sites while healing is taking place

xenograft

graft taken from a different species

heterograft

graft taken from a different species

This type of pedicle flap contains an artery and vein

island pedicle flap

This type of pedicle flap contains an artery, vein, and nerve

neurovascular pedicle flap

lentigines

liver spots

cervicoplasty

removal of excess skin from neck

rhytidectomy

removal of wrinkles by pulling the skin tight and removing the excess

decubitus ulcer

pressure ulcer/bedsore

How many stages of pressure ulcer are there?

4 (I-IV)

What kind of tissue transfer is bundled into the pressure ulcer codes?

Adjacent tissue transfer. Code separately any myocutaneous flap closure, muscle flap, or free skin graft.

Electrosurgery, cryosurgery, laser, and chemical are examples of what type of procedure?

Destruction of lesions (other than excision)

How are Destruction subsection codes divided?

Type of lesion (benign or malignant), number of lesions, and/or size of area destroyed. Malignant lesions are further divided by location.

How are Mohs Micrographic surgery codes divided?

Based on the stage of the surgery and the number of tissue blocks.

"The ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure."

Destruction

Condylomata, papillomata, molluscum contagiosum, herpetic lesions, warts, milia, and actinic keratoses are examples of what?

Benign, premalignant, or malignant lesions

If biopsy of suspected skin cancer is peformed on the same day as Mohs surgery, how is this coded?

Mohs (17311) is primary procedure. Also report diagnostic skin biopsy (eg 11100 and 11101-59) and frozen section pathology (88331-59)

If repair is performed after Mohs surgery, is this bundled?

No. Use separate repair, flap, or graft codes.

Are herpetic lesions benign, premalignant, or malignant?

benign

Incisional biopsy

incision made into the lesion and small portion removed for biopsy.

excisional biopsy

entire lesion is removed for biopsy

Partial mastectomy

only a portion of breast tissue is removed (aka lumpectomy)

Simple or complete mastectomy

entire subcutaneous tissue and breast tissue are removed. Nipple and skin may be left (subcutaneous mastectomy).

Modified radical mastectomy

removal of breast and axillary lymph nodes. May also remove pectoralis minor.

Radical mastectomy

removal of entire breast, pectoral muscles and axillary lymph nodes.

What modifier is used to indicate a procedure is performed on both breasts

-50 (Bilateral Procedure)

What three activities are considered included components of wound repair?

ligation (of vessels), simple exploration, and average debridement

Division of malignant lesions is based on what two variables?

Location and diameter

What is the difference between a Mohs' stage and a block?

A stage one of a number of thicknesses of an area removed for examination. A block is an area from which a stage is incised.

Which modifier is not used when reporting skin tag removal?

-51

When coding the excision of a lesion, the size of the lesion is based on what kind of margin measurement?

narrowest width of margin

For unusual or complicated excisions of the skin that go into the deeper tissues, you should use a code from what section of the CPT manual?

Musculoskeletal Section

onychocryptosis

ingrown toenail

What is the difference between excision and destruction?

Excision is the full-thickness removal of a lesion, including margins, and includes simple closure. Destruction is the ablation of tissues by any method, not usually requiring closure.

Elastic material formed into a sac that is then filled with fluid or air.

tissue expander

aden/o

in relationship to a gland

adip/o

fat

albin/o

white

aut/o

self

caus/o

burning sensation

cauter/o

burn

crypt/o

hidden

cutane/o

skin

cyan/o

blue

derm/o, dermato/o

skin

diaphor/o

profuse sweating

eosin/o

rosy

erythem/o

red

erythr/o

red

heter/o

different

hidr/o

sweat

ichthy/o

dry/scaly

jaund/o

yellow

kerat/o

hard

leuk/o

white

lute/o

yellow

melan/o

black

myc/o

fungus

necr/o

death

onych/o

nail

pachy/o

thick

phyt/o

plant

pil/o

hair

poli/o

gray matter

rhytid/o

wrinkle

rube/o

red

seb/o

sebum/oil

staphyl/o

clusters

steat/o

fat

strept/o

twisted chain

squam/o

flat/scalelike

See More

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set