# closure ?



## codedog (Jun 8, 2011)

I want to bill cpt code 11422  with dx as 706.2,  other coder says it should be 21012 because doc  went  subcutaneous-,, , path report came back as a pilar cyst , also doc office says if using 11422 add a closure code. Gee, 3 different coders , 3 different  anwsers,and I KNOW there is only one way- Which way is right?
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POSTOPERATIVE DIAGNOSIS:  Posterior scalp mass, clinically epidermal inclusion cyst.
OPERATION:  Excision of scalp mass around 2 cm.
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LAP SPONGE AND NEEDLE COUNT:  Correct.
PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, was transferred to the operating table, and underwent laryngeal mask anesthesia.  The area was shaved and prepped and draped in the normal fashion.  The area had been examined by me in the preoperative holding area and was prepped with Betadine solution.  Incision was made directly over the mass for around 3 to 4 cm.  Dissection was carried down through skin and subcutaneous tissue.  The entire mass which appeared to be clinically an epidermal inclusion cyst was removed with the surrounding tissue.  It was sent to Pathology for permanent sectioning.  Excellent hemostasis was noted to be obtained.  I did not go deeper to the cranium at all.  The wound was then closed with 3-0 nylon single horizontal mattress suture in the middle and two simple interrupted on either side.  Bacitracin was placed over the dressing.  There was also noted to be excellent hemostasis.  The patient tolerated the procedure and was transferred to the recovery room in stable condition.


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## surgonc87 (Jun 8, 2011)

haha, everyone is right!
Reporting just 21012 is more correct though. You can also go with 11422 w/repair, 1 more RVU for that selection compaired to 21012 if you want.

MS


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## codedog (Jun 8, 2011)

so if  the excision is subcutaneous , then its not integumentary, ?


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## surgonc87 (Jun 8, 2011)

this is a grey area. the initial report mentions of an inclusion cyst. To report this initially would be in the integuementary code as disease is based off of cutaneous origins. Now that you know the path results, it can sway you to another code selection, none being wrong or right, its what justifiable. 

If it was documented right away a soft tissue mass, margins were taken, then go straight to the 20000 codes. So In my opinion, either way goes.


Hope this helps
MS


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## ASC CODER (Jun 9, 2011)

Well in my opinion if it STARTS ON THE SKIN example melanoma, cyst etc. Then it is integumentary. Those codes can also go subq.  If it is UNDER the skin and goes subq then the musculoskeletal codes......


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