# Need help on Coding Lesion removal



## KristieStokesCPC (Jul 23, 2008)

SUBJECTIVE:

CC: 
Mr. X is a 76-year-old male.  He is here for skin tag removal.  

Current Problems: 
Atypical mole 
Congestive heart failure 
Hip pain 
Osteoarthritis 
Other primary cardiomyopathy 

Immunizations: 
None

Allergies: 
Morphine:
Codeine:
Lortab:
Cipro:

Current Medications: 
Coreg 25mg Tablet Take 1 tablet(s) by mouth bid 
Lasix 40mg Tablet Take 1 tablet(s) by mouth bid 
Prinivil 20mg Tablet Take 1 tablet(s) by mouth twice daily 
Ultram 50mg Tablet take 1-2 po q6-8hrs 
Darvocet-N 100 100mg/650mg Tablet one po as needed for pain q 8 hours 
Allopurinol 100mg Tablet Take 1 tablet(s) by mouth daily 
Flagyl 500mg Tablet Take 1 tablet(s) by mouth tid for 10 days 
Prilosec 20mg Capsules, Extended Release Take 1 capsule(s) by mouth daily 

OBJECTIVE:

Vitals: 

Current: 7/22/2008 4:52:44 PM
Ht: 73.2 inches;  Wt: 270 lbs;  BMI: 35.43
T: 97.6 F (oral);  BP: 95/55 mm Hg (left arm, sitting);  P: 69 bpm (left arm (BP Cuff), sitting);  R: 16 bpm

Procedures: 
Atypical mole 

Procedure Note: 
Informed consent obtained in writing.  He expresses understanding that a scar may remain after the lesion is removed.  Sterile technique is observed.   
Benign appearing lesion #1 is located on right lower lateral thoracic.   The method of removal is excision.   Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   Hemostasis is achieved with cautery.   The specimen is sent for pathology review.   
Benign appearing lesion #2 is a seborrheic keratosis located on right upper lateral thoracic.   The method of removal is excision.   Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   The wound is closed with 3 simple interrupted stitch(es) using 4-0 Ethilon.   The specimen is sent for pathology review.   
Lesion #3 is round brown with white outer border, roots - came out in ball - center of back.   The method of removal is excision.   Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   Hemostasis is achieved with application of pressure.   The specimen is sent for pathology review.   
Benign Lesion #4 is a seborrheic keratosis located on mid back.   The method of removal is shave removal.   Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   Hemostasis is achieved with application of pressure.   The specimen is sent for pathology review.   
Benign Lesion #5 is a seborrheic keratosis located on mid back.   The method of removal is shave removal.   Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   Hemostasis is achieved with application of pressure.   The specimen is not sent for pathology review, as it is clearly benign.  

Congenital accessory skin tags 

Procedure Note: 
Informed consent obtained in writing.  He expresses understanding that a scar may remain after the lesion is removed.  Sterile technique is observed.  Multiple skin tags are located left side of scalp (in hair) above left ear.   A total of one skin tag(s) removed today. Anesthesia was obtained with 0.5 cc of 1% lidocaine with epinephrine.   The method of removal is shave excision.   Hemostasis is achieved with cautery.  


ASSESSMENT: 

238.2	    Atypical mole 
757.39	    Congenital accessory skin tags 

PLAN: 

 Atypical mole 

  Orders: 
     Excision, benign lesion, except skin tag, trunk, arms, legs; lesion diameter 0.6 to 1.0 cm  
            A4550  Surgical trays (x1) 
     Excision, benign lesion, except skin tag, trunk, arms, legs; lesion diameter 1.1 to 2.0 cm  
            A4550  Surgical trays (x1) 
     Shaving of epidermal or dermal lesion, single lesion, trunk, arm, legs; lesion diameter 1.1 to 2.0 c  
     Shaving of epidermal or dermal lesion, single lesion, trunk, arm, legs; lesion diameter 0.6 to 1.0 c  

 Congenital accessory skin tags 

  Orders: 
     Removal of skin tags, multiple fibrocutaneous tags, any area; (initial 1-15)  


CHARGE CAPTURE: 

Primary Diagnosis: 
238.2	    Atypical mole 

Orders:
99211  Office/outpatient visit; established patient, level 1  

757.39	    Congenital accessory skin tags 




I think it would code:
17110
11401
11402
11301
11302

no office visit....


Please help, I'm confused

Thanks
Kristie Stokes CPC-A


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## Lorisvg (Jul 26, 2008)

I didn't see any mention of lesion size in the description of how the procedure was done, just at the bottom.  I'm not sure where you got sizes, so I can't say an exact CPT#. You do seem to be missing one of the excisions, and the 17110 is for destruction of benign lesions, except for skin tags. I would use 11200 instead.

11400-11406 (depending on sizes) for the 3 excised back lesions
11300-11303 (depending on sizes) of the 2 shaved back lesion
11200 for the skin tag

I also wouldn't charge an OV.


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