# Please Help!!! - integumentary system



## Walker22 (Jan 8, 2010)

This is not my area of expertise, but I'm going to venture an educated guess of 11042. Breast tissue is generally considered part of the integumentary system as far as I know. I'm sure there is someone out there with more experience than me though.


----------



## LTibbetts (Jan 8, 2010)

mdunn said:


> I need some input on how to code a debridement of fat necrosis of the breast following a breast reconstruction. I don't think it's a revision but I don't know which debridement code to choose. I have posted this question a few times with no response. Surely someone out there knows the answer.



Which code were you thinking to use? It might be easier to help, and that way we don't just give you an answer. This way you'll learn more. That might be why you are not getting an answer??


----------



## LTibbetts (Jan 8, 2010)

mdunn said:


> Well, I really don't know what to use. If I knew I wouldn't be asking this question. I have been back and forth and have researched this for over 2 weeks with no luck. I feel like it would be a debridement code but none of them really seem to fit. I am coding for the hospital and the doctor coded 19380 for his office charges but I really don't feel like that is correct.



Obviously you are asking because you don't know the answer. I was just trying to say that a lot of the time, we just bounce things off one another and when we present the codes we choose, we get more of a response (ie disagree, agree, etc). That's all I meant. I didn't mean to offend or upset you. Only trying to help


----------



## FTessaBartels (Jan 8, 2010)

*Why do you think 19380 is wrong?*

Can you post the scrubbed operative report?

Why do you think 19380 is incorrect?

F Tessa Bartels, CPC, CEMC


----------



## LTibbetts (Jan 11, 2010)

mdunn said:


> no problem. I just don't want it to seem like I haven't even tried to come up with a code. I have been over and over this and it seems like when no one responds to your question after posting it 3 times, nobody knows. I guess that makes me feel a little better knowing I'm not the only one. I just need to get this chart coded and off my desk and I don't know what to use. Can anyone explain the difference between the partial thickness and full thickness debridements?



I can definitely relate and have been there too many times myself. I may be able to help explain the full & partial thickness but it is a very generic description. Partial thickness is the epidermis and dermis (like a 2nd degree burn,although, I know that you are not talking about burns for this case) and full thickness is considered to also include the subcutaneous tissue as well as the epidermis and dermis layers (such as a 3rd degree burn). As i said, a little generic but it may help a little. As for the code to use, I am not sure but i will try to look into it sometime today and see if I can help. Try posting the op note as Tessa suggested. She is pretty helpful in a lot of situations and can probably help you better than I can


----------



## LTibbetts (Jan 11, 2010)

This is the lay description of a breast revision. I am still not completely sure but it looks to me like the 19380 might be the better choice. It includes dissecting tissue and your op note claims to be doing the same. Also,I couldn't seem to find a debridement code that seem to qualify either. Did you find a debridement code that you thought was suitable? Now I see where all of your confusion lies. 

CPT Lay Descriptions 
10021 - 19396	30000 - 39561	50010 - 59871	70010 - 79445	90281 - 99607
20000 - 29907	40490 - 49906	60000 - 69990	80047 - 89356	0016T - 0198T


19380 

Revision is done on a reconstructed breast, usually to correct a problem with asymmetry. The physician makes an incision in the breast skin along the areola or at the fold under the breast or in prior surgical incisions. Tissue therein may be rearranged or secured with sutures to revise the shape of the reconstructed breast. An existing breast prosthesis may be replaced with a prosthesis of a different configuration. Excess skin or tissue from the reconstructed breast may be removed. Once the breast has been revised to its desired shape, the physician repairs the incision with layered closure.


----------



## LTibbetts (Jan 12, 2010)

You might be right on that since I don't do hardly any breast reconstructions or revisions here. After looking closer at the description for the 11042, it looks like you may be right on this one. Does the physician give any idea at all what he/she is thinking on this chart? Are they expecting it to be the 193xx code? I only ask because I can't remember if you do facility or pro fees. Is there any way that you can query the physician and try to see where they were heading with this one and what they expect to charge for it? I'm probably no help at all on this anymore, but I can't seem to help myself..haha


----------



## FTessaBartels (Jan 12, 2010)

*I only code pro*

I only code professional fees.  But I would be comfortable using the 19380.  While it is "usually" done to correct assymetry, that isn't the only reason for a revision. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


----------



## LTibbetts (Jan 13, 2010)

I looked into this some more and then discussed it with a coding supervisor friend of mine yesterday that does these surgeries frequently and she claimed the same as Tessa, that it would be considered a 19380. Guess I should've done that in the first place, I could've been more helpful a lot sooner. Hope it works out for you


----------

