# Melanoma down to the Fascia



## vjst222 (Jul 11, 2017)

I have a few questions - I have a patient who had a 1.1 centimeters excision of melanoma insitu with wide margins up the upper arm 
 Here is the majority of the OP report 

 Patient taken to OP room , General anesthesia was done . An Elliptical incision was made and carried DOWN TO THE FASCIA , the lesion was then removed  and a stitch placed at the 12 oclock for orientation purposes. we then widely undermined the tissues using electrocautery so that we could effect a primary closure . 

 Path came back - Melanoma in Situ 

 Path says the following : skin biopsy , skin left arm, superficial spreading melanoma in situ : received in formalin pink tan skin with underlying fatty tissue

 So here is my question : Since the excision went down to the fascia, would this be a code that codes to the integumentary system or will this get coded to the musculoskeletal system. I need solid proof . 
 I thought perhaps it would code to 24075 ,however, I was told since melanoma is a skin lesion originally it would only be coded to the 11602 .
 I guess I am looking for SOLID proof that states, melanomas can only be coded to the 11600 series .

 I thought the musculoskeletal codes were used for patients where the excision went down to subcutaneous regardless of if it was cancer or not cancer. 

 Any advice or help is appreciated.


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## ellzeycoding (Jul 11, 2017)

24075 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; less than 3 cm
24071 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; 3 cm or greater
24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (e.g., intramuscular);
less than 5 cm
24073 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (e.g., intramuscular); 5
cm or greater

Layers of skin...

dermis
epidermis
subcutaenous fat
fascia
muscle (i.e.sub-fascia)

HOWEVER, just because you cut that far doesn't mean you code that far.  You should code based on where it was located.

According to the AMA, you should use the soft tissue excision codes *when the tumor is located in the subcutaneous, fascial or muscular location.*

The path report shows it was SUPERFICIAL, or on the surface.

Use the 11602 series

The 2407X series codes are usually for cysts/lipomas located further down.


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## vjst222 (Jul 11, 2017)

Thank you - 
 I will keep all this in mind the next time I have one similar 




ellzeycoding said:


> 24075 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; less than 3 cm
> 24071 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; 3 cm or greater
> 24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (e.g., intramuscular);
> less than 5 cm
> ...


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## krssy70 (Jun 9, 2020)

ellzeycoding said:


> 24075 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; less than 3 cm
> 24071 Excision, tumor, soft tissue of upper arm or elbow area, *subcutaneous*; 3 cm or greater
> 24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (e.g., intramuscular);
> less than 5 cm
> ...


Hello,

I was wondering if you could share the link from the AMA where I can find this info?? 

Thanks


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## wisibyusha (Jun 12, 2020)

I just want to point out that in the OP, it stated that the INCISION was carried down the fascia to carry out the EXCISION of the lesion. It was wise question though!


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## such78 (Jul 23, 2020)

wisibyusha said:


> I just want to point out that in the OP, it stated that the INCISION was carried down the fascia to carry out the EXCISION of the lesion. It was wise question though!



based on pathology report, the tumor was located superficially. If the pathology report didn't indicate the depth of tumor, I would code as fascia.


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## such78 (Jul 23, 2020)

suchang78 said:


> based on pathology report, the tumor was located superficially. If the pathology report didn't indicate the depth of tumor, I would code as fascia.



I apologize for the wrong info I provided.  The size and depth excision should not be picked from pathology.


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