# Excision of lipomas 23071



## pwright3603 (Oct 21, 2010)

I have had an audit done on a operative report that says I should have coded 12032 for layer closure in addition to 23071.  They agree with the 23071 and 214.1... I felt that the layer closure is included in the code for excison of tumor soft tissue less that 3 cm.  Can anyone add to this to clear it up for me?
thanks so much! p.s. would you have sequenced 11600 before 23071 just because the dx was 173.6?


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## rsboggs (Oct 21, 2010)

I also have trouble when coding for the lipoma excisions. My surgeon often does layered closures that we do not charge for due to the size of the lesion/lipoma he removed because I am in the same thinking as you. 

As far as the sequence of the codes, I would have billed the 23071 before the 11600 due to the higher charge.


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## RCBBuell (Oct 21, 2010)

Hi,

We do these all the time.  I have six surgeons and I do not charge for the closing.  I figure it is in the excision.  I have never been told differently.  What kind of audit was it that told you you should?


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## preserene (Oct 21, 2010)

The cpt guide line states that Excision- BenignLesions- Closure of defects created by incision/excision or trauma may require intermediate or complex closure.Repair by interm or complex must be reported separately 
It includes only nonlayered (SIMPLE) closure when performed.


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## pwright3603 (Oct 22, 2010)

Are you including the 20000 series codes to that statement as well?  thanks ...


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## Pam Brooks (Oct 22, 2010)

CPT 2010, in the green text under Musculoskeletal System Excision of subcutaneous soft-tissue tumors , it states "_extensive undermining or other techniques to close a defect created by skin excision may require a complex repair which should be reported separately_."  (CPT Professional Edition, AMA, p.86).  Code 12032 is an intermediate repair, not a complex repair.  In this guidance, CPT is referring to adjacent tissue transfers such as Z-plasty, or complicated closures in the 131XX range.  The excision codes in the integumentary system allow for additional code reporting for the intermediate closure, but you coded from the Musculoskeletal system, so that would not apply.  I think your auditor may be incorrect, but it depends on what was truly documented. 

Any time we bring in an external auditor, we contract for the opportunity for our coders to participate in a 'rebuttal' session, to address coding recommendations made by the auditor that we deem incorrect.  We also ask for regulatory guidance on any coding recommendation where the auditor suggests we made a coding error.  

Let us know how this turns out.


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## pwright3603 (Oct 22, 2010)

thanks for the great feedback all of you! I will let you know the outcome as I feel vindicated to some degree!


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