# musculoskeletal vs integumentary?



## BFAITHFUL (Nov 3, 2009)

I have two op notes where i'm thinking musculoskeletal vs integumentary?

1. Our Doc did an excision of a 4cm x 5cm mass describing it as following:

A mass was noted in upper back immediately by the junction of the lattisimus muscle. careful identification of the neurovascular structures and then movable in its entirety. general anesthesia administered, patient had direct incision made directly overlying the mass. Large skin flaps were raised, the patient had a well defined mass that was lipomatous in nature. significant filling blood vessels were noted. these were cauterized, the neurovascular pedicle was avoided and was done. the space closed with deep sutures of 4-0 Vicryl. patient had dermise was closed with 4-0 Vicryl and then skin was closed with 5-0 prolene. pathlogy report states: skin, left shoulder - excision, Lipoma. 8.0 x 6.0 x 3.0cm is yellow circumscribed fatty tissue.

Our Doc seems to think he can use excision codes 114xx & intermed. repair 12xxx, but I'm not too sure, doesn't this look like it should be deeper than skin (codes from the musculoskeletal) instead of the integumentary??

2. Same type of scenario, Doc did excision of mass of left upper forearm 1.5cm by 1.5cm repair of subfascial. 

Patient has briefly had cancer of the breast and there is a possibility this might be a cancer, Subfascial, there is overlying skin was abnormal. This will be resected in addition, First done on the patient had elliptical excision of skin and subcutaneous tissue and then careful dissection was down under the biceps. The mass in this area was then located, it was carefully identified. All feeding blood vessels were cauterized and once this was completed, the patient then had the area of managed closing deep space with 4-0 Vicryl, the dermis with 4-0 Vicryl and skin with 5-0 Prolene. : 
Path. report shows: Minature Lipoma, recd an ellipse of skin with attached underlying subcutaneous tissue nodule, skin measures 2.0x .9x0.1cm, and the subcutaneous nodule measures 1.2 cm. On section it reveals yellow adipose tissue. 

I'm also thinking musculoskeletal codes as opposed to integumentary??

Thanks


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## mitchellde (Nov 4, 2009)

I would go with muscularskeletal.


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## BFAITHFUL (Nov 4, 2009)

thank you


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## FTessaBartels (Nov 4, 2009)

*General rule of thumb*

As a general rule of thumb, any time you go *beneath* the dermis you code from the musculoskeletal section.

I agree with Debra - would definitely code from musculoskeletal system for these two scenarios.

F Tessa Bartels, CPC, CEMC


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## BFAITHFUL (Nov 4, 2009)

Thanks to you both


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