# Leg mass



## codedog

First let me say this 


April 2010 CPT Assistant
Integumentary vs Musculoskeletal Lesion Excisions

In an attempt to clear up frequent confusion over which code to report for the excision of soft tissue tumors, the American Medical Association updated guidelines in the 2010 CPT codebook for these types of procedures. Specifically, guidelines for choosing between the integumentary system and the musculoskeletal system were revised, because making the decision between the two systems is where there is the most confusion for coders.

egumentary codes should be reported when the lesion is removed from somewhere within the full thickness of the dermis, and Musculoskeletal codes should be reported when the lesion is removed from the subcutaneous, superficial, or deep soft tissues under the dermis. When reporting an integumentary code, simple closures are included but intermediate and complex closures should be reported separately using CPT codes 12031-12057 or 13100-13153. The removal of Musculoskeletal lesions includes simple and intermediate closures but complex closures are not included and should be reported separately.

With this said, suppose the operative report state removal of lipoma  greater than 10cm on leg . it was removed as dissectionn was carrired down through the skin and subcutaneous tissue. The mass clinially did not go down to the fat.  The wound was closed with3-0 Vicryl AND 3-0 nylon. 
now would you code it as 27337 -which only states subctaneous not subfascial or would you code it in the  integumentary system? tHANKS


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## purinoski

*Leg Mass*

Depending on whether the mass or fatty tumor (lipoma) was from the thigh area or tib-fib area, why couldn't 27337 or 27632 be used?  Was there a path report?


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## codedog

yes , 27632 is a better choice, but doc  makes me question about  it because he said he did not go down to fat , so  would that make it integumentary code ? not sure , please explain


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## purinoski

If you have a 2010 Coders' Desk Reference the27632-27634 states "These are resequenced codes.  Please see 27618-27319 for the lay description."

27618-27619, 27632-27634
The physician removes a tumor from the soft tissue of the leg or ankle area that is located in the subcutaneous tissue in 27618 and 27632 and in the deep soft tissue, below the fascial plan, or within the muscle in 27619 and 27634.  With the proper anesthesia administered, the physician makes an incision in the skin overlying the mass and dissects to the tumor.  The extent of the tumor is identified and a dissection is undertaken all the way around the tumor.  A portion of neighboring soft tissue may also be removed to ensure adquate removal of all tumor tissue. . .

Hope this helps.
Phyllis Urinoski, CPC


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## nsteinhauser

I'm still confused on this one, too - and I have the lay description/ desk reference notes - I have the same question - I have a surgeon that takes out a lipoma that was clearly SUBCUTANEOUS because it was below the full dermis.....so I don't use an integumentary code for lesion excision.... I can use one of the tumor codes.  BUT - in the lay descriptions for the  tumor codes, it explains 'SUBCUTANEOUS' for one pair ...or.... 'SUBFASCIAL OR INTRAMUSCULAR' for the other..... meaning below the fascia or in the muscle, right?  SO - if the surgeon specifies that it was below the skin - so subq - but doesn't specify that it was below the fascia or doesn't specify it was excised out of muscle, then we have to stay with the tumor code for the subq...?


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## codedog

SAME QUESTION, any one have an answer ppppppppppplease


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## bethh05

Yes, as long as the op report states subq I would use the musculoskeletal codes for subq, not subfascial. I also look at the path as it usually states what tissue was sumbitted (skin, subqutaneous, soft tissue, etc) to help. Also the definition of lipoma is a benign fatty tumor usually found in the soft tissue. Hope this helps!


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