# How would you approach this ?



## codedog (Jan 13, 2011)

Doc did this dictation and to me I feel its not enough info for it( SIZE of lipomas ). Path report came back all lipomas. Now since he did not dictate size  inoperative report -do  i good them from path ?
example - path said  received in formalin is a segment of tan -pink well encapsulated fat that measures 3.0 x 1.5 x 1.5cm. ,AND 5 more just close to the same thing,just   different sizes and areas. So would I select 3.0 for the size,or go to the lowest which would be 11400,?
 thanks for your time 

POSTOPERATIVE DIAGNOSIS:  Multiple abdominal wall masses and left leg mass, clinically lipoma.
PROCEDURE:  Excision of masses x6.

PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, transferred to the operating table and underwent general anesthesia with endotracheal tube.  All areas were marked in the preoperative holding area, was prepped with DuraPrep solution.  Prior to using Bovie cauterization, three minutes were waited.  The specimens were all labeled and sent separately.  Attention was first given to the left lower leg wound.  Incision was made and carried down through the skin and subcutaneous tissue.  What was clinically a lipoma was removed.  Excellent Bovie cauterization.  All six removed in the same fashion and they were labeled left leg, left abdomen, right mediosuperior, right lateral superior, right inferomedial, right inferolateral.  They were all sent separately.  Again, everything was closed in two layers with staples on the skin.  The patient tolerated the procedure well.  A sterile dressing was placed.  He was transferred to the recovery room in stable condition.


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## codedog (Jan 15, 2011)

i like to hear anything


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## ASC CODER (Jan 17, 2011)

I would first see if you can query the doctor. If not then you would use the path. Because of the formalin shrinks the specimen than the doc might be losing some money. Good Luck.... I had one doc last summer tell me that one was the size of a baseball and the other was the size of a small tennis ball. lol So I had the conversation about stating the dimensions so he could get max reimbursment.  wouldn't you use 27632 for the leg??


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## codedog (Jan 17, 2011)

27632 fpr leg, thats where I get confusd, some coders say use 1140x, while other say go into 200xx series.,hmm, confusing


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## ASC CODER (Jan 18, 2011)

Here is an exerpt from Margie Vaught,

April 2006 CPT Assistant: "Question: What is the correct CPT code to report for EXCISION of a LIPOMA from the right flank?

 AMA Comment: From a CPT coding perspective, LIPOMAs are typically benign tumors that may occur sporadically or with an underlying genetic predisposition. In only the rarest of incidences are they anything but benign. While usually asymptomatic, they will produce symptoms due to their location, ie, over bony prominences or in areas that are compressed (eg, the buttocks). LIPOMAs may be found in multiple locations pathologically. While commonly in superficial tissue, they can also be present in subfascial and submuscular locations. Often the tumors are well defined, but, at times, the lesion may wrap around the nerves and blood vessels, complicating removal. 



When a LIPOMA is present in a superficial location, it would be appropriate to use an EXCISION code from the integumentary system (eg, 11400-11446, EXCISION, benign lesion). However, when the LIPOMA is in a deep subcutaneous, subfascial, or submuscular location, an appropriate code from the MUSCULOSKELETAL system (eg, 21930, EXCISION, tumor, soft tissue of back or flank) would be reported to describe more closely the work entailed. Therefore, it will be necessary to consult the procedure report to determine the physician work involved in removing the LIPOMA."


If the Lipoma or tumor or mass is in the subcu than I use the musculoskeletal if it is superficial example Melanoma.... I would use the 11xxx codes.... I hope that helps..


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## codedog (Jan 18, 2011)

oh,asc coder this help, thank you so much


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## ASC CODER (Jan 18, 2011)

your welcome....


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