# Lipoma removal(s) help!!



## smcbroom

I would like to get some opinions regarding this op report.  We are trying to come to an agreement in our office in regards to this procedure.  The surgeon's office coded as 24075x1 and that's not right since there were some on each forearm.  Our consulting company is telling me to only bill up to 3 lipoma removals since most insurance companies only pay up to 3 procedures but our contract with this insurance doesn't have a maximum amount of procedures that they pay so I don't want to undercode.  Can someone please offer their advice, should it be x12 (path report shows 12 specimens) or what???? I appreciate your time in reviewing this.

Susan


PREOPERATIVE DIAGNOSES: 	Bilateral lipomas on forearms.	

POSTOPERATIVE DIAGNOSES:	Bilateral lipomas on forearms.	

OPERATION:	Excision multiple forearm lipomas times eight on the left arm, times four on the right arm.

ESTIMATED BLOOD LOSS: 	Less than 20 cc.

IV FLUIDS:	Crystalloid.

PATIENT HISTORY:  presents with a longstanding history of multiple slow growing masses in the subcu of both forearms consistent with multiple lipomatosis.  The nature of the surgery as well as the limitations, expected outcome and alternatives were discussed preoperatively along with possible risks, complications and side effects including but not limited to hematoma, infection, seroma, recurrence, scarring and nerve injury.  The patient consents to proceed.

PROCEDURE IN DETAIL:  The patient was marked preoperatively in the holding area and brought back to the operating room where he was placed under general anesthesia with sequential compression devices in place.  He was also given antibiotic.  Multiple transverse incisions were made over the forearm palpable and soft mobile masses.  Dissection was then continued through the subcu where multiple encapsulated lipomas were identified, ranging in size from 1 cm diameter to 6 cm in diameter.  These were all passed off the table as permanent specimens to pathology.  A layered closure was then performed on each incision site to include 5-0 Vicryl in the deep dermis and a 4-0 subcuticular Monocryl.  Steri-strips were placed over each incision.  He was then wrapped in sterile Curlex dressings and transferred to the recovery room in stable condition.  There were no complications.  All counts were correct at the end of the case.


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## smcbroom

oh...and I work for an ASC and it's a commercial payer, not Medicare, etc.

Thanks!
Susan


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## lphillips

*lipoma removal*

Since you state forearm, would that not be 25075?

I would charge 25075x12 -51, as long as all lipomas were excised through seperate incisions. Op report states "multiple transverse incisions" - however I would queary the physician as to the exact number of incisions. Was there a chance that multiple lipomas were excised through the same incision? If so, I wouldn't charge x12 - but charge for the actual number of incisions made. My thinking is that if you are using the same incision to remove multiple lipomas you would only charge for the one incision.


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## scgcpc2002

*Lipomas*

I also work for an ASC and when the MD's dictate multiple lipomas removed, I query if each one was done separately if so I'll bill it out that way...


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## smcbroom

Yes, I totally agree with the 25075 and I did correct it originally once I saw the MD used 24075.  Good idea about asking the surgeon how many incisions were made, I think there was a rush coding this one since it was end of month and we did not ask her that question.  I will ask her that today.

Thank you so much for your input!


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## trose45116

i would also have the dr dictate in the scrub part of the note the number of each lipomas on each arm that part of the op note is what you go by. also how many incision were made on each arm.


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## mad_one80

YES, I agree...having the doctor dictate the #s of lipoma on each area/arm is a great idea...also 25075x12 -59 would be a better coding choice since ASC's dont recognize the -51 mod for commercial payers!


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## magnolia1

I agree with mod "59" in this case.


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## scgcpc2002

*lipomas*

I too work for an ASC and I would code each separately using the 59 modifier


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