Ch 18 Integumentary System
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.
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.
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?
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?
flat are of color change; no elevation or depression
solid elevation; less than 0.5cm diameter
solid elevation 05.-1.0cm diameter; extends deeper into dermis than papule
solid mass larger than 1cm
flat elevated surface found where papules, nodules, or tumors cluster
type of plaque; result is transient edema in dermis
small blister; fluid within or under epidermis
larger blister; greater than 0.5cm
flakes of cornified skin layer
dried exudate on skin
cracks in skin
loss of epidermis that does not extend into dermis
area of destruction on entire epidermis
excess collagen production following injury
loss of some portion of the skin
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?
nonlayered closure (included in the codes for lesion excision).
layered closure (code separately per notes)
greater than layered closure (code separately per notes)
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)
chronic abscessing and subsequent infection of a sweat gland
Surgical separation and removal of the nail plate to preserve the root so the nail will grow back (11730, 11732).
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.
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.
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.
To correctly code a graft, what information is needed?
Type of graft
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
Full thickness skin graft
graft taken from patient's body
graft taken from a human donor
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
graft taken from a different species
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
removal of excess skin from neck
removal of wrinkles by pulling the skin tight and removing the excess
How many stages of pressure ulcer are there?
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."
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?
incision made into the lesion and small portion removed for biopsy.
entire lesion is removed for biopsy
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.
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?
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?
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.
in relationship to a gland
an instrument to cut
incision and drainage
subcu, subq, SC, SQ
tuberculin skin test
lack of color pigment
homograft, same species graft
condition in which hair falls out
deficiency of sweat
from pt's own body
ripping or tearing away of part either surgically or accidentally
removal of a small piece of living tissue for diganostic purposes
protein substance of skin
cleansing of or removal of dead tissue from a wound
pedicle of skin with blood supply that is separated from origin over time
planing of skin by means of sander, brush, or sandpaper
surgical repair of skin
cauterization by means of heated instrument
loosening of epidermis
superficial fungal infection
surface covering of internal and external organs of body
redness of skin
surgical incision into necrotic tissue
cleft or groove
free full-thickness graft
graft of epidermis and dermis that is completely removed from donor area
nodule in skin caused by Staphylococci entering through hair follicle
localized collection of blood, usually result of a break in a blood vessel
allograft, same species graft
skin disorder characterized by scaling
island pedicle flap
to contains a single artery and vein that remains attached to origin temporarily or permanently
depigmentation of skin
white patch on mucous membrane
dark pigment of skin
tumor of epidermis, malignant and black in color
Mohs' surgery or Mohs' micrographic surgery
Removal of skin cancer in layers by a surgeon who also acts as a pathologist during surgery
transfer of muscle from origin to recipient site
contains artery, vein, and nerve
growth attached with a stem
pertains to hair follicles and sebaceous glands
excess sebum secretion
all epidermis and some of dermis
fat mass in sebaceous gland
tumor composed of cells containing lipid material, yellow in color
different species graft
dry, discolored, scaly skin
If a patient's rash is caused by a drug reaction, what type of additional code is needed?
E-Code to identify drug
premature shedding of hair; can be the result of childbirth, shock, drug intake or fever
Wounds that have delayed healing/treatment, foreign body, or injection are called what?
What is it called when a wound is left open and requires sutures at a later date?
Between a punch biopsy and a shave biopsy, which usually requires suturing?
During Mohs surgery, each time the surgeon removes a portion of the tumor, it is referred to as a ________.
During Mohs surgery, each stage is mapped an divided into ________ ________.
excessive development of the breasts in males
Melanocytes exist in which layer of the skin?
stratum basale (stratum germinativum)
Electrodessication is what kind of lesion treatment?
What do you reference in the CPT index to code the excision of a cyst?
Excision, Lesion, Benign