# excision of lesion + closure vs Modifier



## rachell1976 (Feb 28, 2008)

I have a general surgeon who removed a lipoma from a patient's thigh. 

He coded it 11406 with modifier 22.

However when I read his OP note I belive it should be coded with the 11406 and a layered closure code.

I'm newly certified and not 100% confident enough to tell an experienced surgeon he is wrong. any imput would be wonderful.


PROCEDURE:  Excision of soft tissue mass.

OPERATIVE FINDINGS:  There was a 14 x 9 x 6 cm, well circumscribed,
bilobed soft tissue mass in the anterior left thigh just below the groin
crease.  The mass was interposed between the rectus femoris muscle and
vastus lateralis muscle by MRI.  It was said to be deep to the
superficial fascia; however, it was deep to the fascia of the 2
above-named muscles.  The mass was yellow, well circumscribed and did
not appear to originate from the muscles themselves.  It was grossly
consistent with a lipoma, although a little bit firmer than the usual
lipoma.

PROCEDURE NOTE:  After the induction of satisfactory general
endotracheal anesthesia, the patient was prepared and draped in a
sterile manner in the supine position.  The left leg was rotated
laterally and a cushion was placed behind the left knee.  A transverse
skin incision was made in the long axis of the palpable mass and carried
down sharply through the superficial fascia of the thigh.  The fascia of
the anterior musculature of the thigh was identified.  The mass was deep
to this fascia.  The fascia was divided and the soft tissue mass
immediately identified.  This was freed from the musculature using
primarily blunt finger dissection aided by electrocautery dissection.
The mass was excised completely.  Hemostasis was assured and the wound
flushed with 0.5 percent Marcaine with epinephrine.  The deep fascia was
closed using running 2-0 Polysorb.  The superficial fascia was closed
using interrupted sutures of 3-0 Polysorb, and the skin was
reapproximated with interrupted vertical mattress sutures of 4-0
Novafil.  Prior to closure, a 10 mm Jackson-Pratt drain was placed
through a separate inferolateral stab wound into the depths of the wound
and secured to the skin with 3-0 nylon.  Sterile light dressings were
applied, and the patient was awakened and sent from the operating room
in stable condition.


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## mmelcam (Feb 29, 2008)

General rule is when the physician goes into the fascia you should go into the musculoskeletal section of the cpt book for your code. Your physician talks about going thru the fascia and dissecting the mass from the muscle. I would use 27328. This would include the layered closure.


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## rachell1976 (Feb 29, 2008)

thanks so much. No matter if you pass the exam.. there is something new to learn EVERY SINGLE DAY!!


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