# coding size from Path report ?



## Justarose (Jul 18, 2011)

Seems like I was told or "heard" some time ago that we can NOT code the size of a lesion from a path report ? 

*This is ASC related *- I need to know for sure and have some proof if the answer is really yes ? 

*Also - Can someone tell me how to recognize the difference between an intermediate and complex closure - his notes are sooo simple - but he codes everything "complex" *My QA'er is telling me they are intermediate ... 

He says *" pts defect was then undermined to remove tension. The skin was approximated using 4-0 PDS ininterrupted inverted fashion to approximate the dermis and 5-0 nylon in interrupted fashion to approximate the epidermis." *

Thank you in advance


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## DeeCPC (Jul 18, 2011)

You do not code the lesion size from the path report.  The skin shrinks so the lesion size would appear smaller.  Eitherway, if they want to get paid then they need to document the work.


Intermediate closures need to be documented as into the deeper subcutaneous, "…layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, *in addition to *the skin (epidermal and dermal) closure."  **your example is not an intermediate closure.

Stating a closure was in layers, intermediate or complex is not enough.  Giving two types of suture materials is not enough.  

Complex is the above quoted description PLUS scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents, or retention sutures.  Extensive undermining is not described in the CPT.  



PS a simple closure of heavily contaminated wounds that require extensive cleaning or removal of particulate matter also constitutes intermediate repair.


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## Justarose (Jul 19, 2011)

Dee ! 

Thank you so much , your infomation was so very helpful !! 

It is good to have armour on !


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## Srinivasan (Jan 24, 2012)

*Closure*

Hi 

document says nevus excision 10 cm with intermediate closure was done, Closure size not mentioned  so can we assume excision size should be equal to intermediate closure, what is the correct coding  intermediate closure 

Thanks
Srinivasan


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