# Help with coding please



## vkratzer

Surgeon did excision of buttock lipoma subcu tissue with layered closure.  Would 27047 be appropriate code and can you also bill for closure separately or would that be included.

Thanks for your help

Vicky K


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## pherder

Procedure code 27047 would be appropriate and includes layer closure.
Hope this helps!


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## mmelcam

I would not use 27047, this is for the pelvis and hip area. You stated that this lipoma was removed from the buttock. I would use an excision of benign lesion code in the integumentary section. Then you would also code for the layered closure.


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## okiesawyers

I agree with Melissa.


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## magnolia1

I agree with Melissa also.


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## vkratzer

Thanks for your help.


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## mbort

If the incision was in the subcutaneous tissue, I disagree with everyone. Before I responded to this, I wanted to confirm my thinking so I put the question out on another list-serve.  Margie Vaught (for those of you that know of her and her awesome reputation) responded with this:

Please see the below CPT assistant:

Year: 2006 

Issue: August 

Pages: 12-14 

Title: Coding Communication: Questions and Answers 

Body: Surgery: Integumentary/ Musculoskeletal System

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.


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## heathermc

I agree with mbort, if it is subq you would use the 21930.


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## cmartin

I'm with pherder -  I think the buttock fits the pelvis/hip area better than the back/flank, at least by the definitions in my medical dictionary (Dorland's).
C.Martin
CPC-GENSG


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## heathermc

In the Taber's Dictionary, it states under flank: The part of the body between the ribs and the upper border of the ilium.  The term also refers loosely to the outer side of the thigh, hip, and BUTTOCKS.


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## mbort

also since the question in the CPT assistant that I posted previously, specifically states FLANK and that was the AMA's answer, I would tend to follow the AMA guides.


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## cmartin

So it looks like this is one of those "gray areas" where you get to pick your poison.  (Dorland's just says "the part of the body below the ribs and above the ilium")


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## cmartin

Whoops - didn't see the last post b/4 replying - but the question we were all responding to specifically said the buttock - had it said the flank, there could be no question which code to use.


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## SUEV

mbort said:


> If the incision was in the subcutaneous tissue, I disagree with everyone. Before I responded to this, I wanted to confirm my thinking so I put the question out on another list-serve.  Margie Vaught (for those of you that know of her and her awesome reputation) responded with this:
> 
> Please see the below CPT assistant:
> 
> Year: 2006
> 
> Issue: August
> 
> Pages: 12-14
> 
> Title: Coding Communication: Questions and Answers
> 
> Body: Surgery: Integumentary/ Musculoskeletal System
> 
> 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.



My doc excised a buttocks lipoma and chose the pelvis/hip code over the back/flank code.  When I read the CPT Assistant's answer, it sounds like they used buttocks only as an example of where a lipoma might lie in a compressed area (vs bony prominences), not as a definitive example of a back/flank lipoma.  The definition of flank includes the "outer side" of the thigh, hip, and buttocks.  My question would be what would you code the "inner side" of the thigh, hip and buttocks?  I think since there's a specific code for thighs & hips, you wouldn't necessarily default to the back/flank code, you'd use the thigh & hip codes for lipomas in those specific areas.  Since the buttocks is on the posterior of the pelvis, & if the lipoma isn't on the "outer side" of the buttocks, I'd feel more comfortable coding it as a pelvis/hip tumor.  Since it's a grey area, does anyone think this argument would hold water if I had to defend the doc's and my choice?


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