# Subcutaneous tissue



## Williealawishes (Dec 18, 2009)

Hello.  I have researched and researched the "subcutaneous" issue with removal of lesions.  I am surprised by the amount of conflicting information regarding *integumentary vs musculoskeletal.*

Most of our outpatient removals are down in the subcutaneous level, usually always needing multiple layered closing.  

I would like to sum up my research and gather any opinions out there.

Rule of thumb....subcutaneous level is musculoskeletal.....because:

1.  This is below the "dermis".....The dermis is documented as the layer of skin between the epidermis and subcutaneous tissues.

2.  Subcutaneous tissue is actually the "superfacial facia" which is made up of "connective tissue" which qualifies for the musculoskeletal system.

I have also summed up that the dx does not need to completely reflect this...example dx could be cyst, lypoma or any lesion....it's all about how far down the actual incision has gone....past the dermis and into the subcutaneous level.

I would LOVE thoughts from others on this.........


----------



## tjanz1418 (Dec 18, 2009)

I agree that it is muskuloskeletal, but what do you do for areas that don't have a good CPT for that such as the abdomen.  Do you revert back to the benign lesion removal with layered closure for those instances?


----------



## codedog (Dec 20, 2009)

Glad this subject came up 

This is what I was told ,  
  To  code Musculoskelel system look for clues in operative report to determine if the codes selection based on the depth of the excision . Words like deep subcutaneous, subfascial, or submuscular 

Sample:A 23 female presents for removal of lesions from her arms and legs. A 2.3 CM  lipoma involving  superficial subcutaneous structures was removed from upper left arm and another 3.5 cm lipoma with layer closure of 6.0 CM  lenghh  was removed from subfascia of left upper thigh.
cpt codes are 27619- for 6.0 cm from subfascia and cpt code 11403 for  superficial . Now this is from  CPT  assistant

NOW HERE IS MY QUESTION
  I understand why they choose cpt code 27619, yes it was deep, but what about the other code , why not 27618, what qualifies for cpt code 27618, what key words. This is where I don't understand. 
I feel like if the operative report states subcutaneous not deep though, then choose the code before the code that just says subcutaneous, 
cpt codes such as 21555, 21930, 27618.
 Any suggestions?


----------



## Williealawishes (Dec 31, 2009)

I think think the issue here Trent is the word "superficial".....if it was listed as just subcu you could agrue the 27618.  
I think these subcutaneous codes that you have pointed out in the musculoskeletal system confirms that lesions removed in the "subcutaneous" level are to not be reported in the integumentary system.
Just my view on things   Tracy


----------



## Williealawishes (Dec 31, 2009)

tjanz1418....I have been using the 22900 abdominal wall removal if it is showing deep subcu....I have found a lot of conflicting info on this one as well....


----------



## Hopp (Jan 4, 2010)

*SubCutaneous tissue*

Hi - Im still fairly new at this; but I am totally confused by this issue.  I was told that if it was a cystic lesion to code by the integ. codes per the CPT book (and use layered closure if Doc stated it was a layered closure)  
Ex: Excision 2cm back lesion with layered closure
Path:Seb.Cyst
Thank you in advance for helping me out with this if you can   Deb,CPC


----------



## BFAITHFUL (Jan 4, 2010)

Now I have a cpt asst. And a coders pink sheet that states the lipoma/lesion has to be specifically stated as being located in the subq area or below just because the incision went thru the dermis doesn't mean you can code the musculoskeletal codes because although lipomas are usually located in subq area there skin lipomas as well.  So documentation has to be clear of where the lesions/lipomas are actually located


----------



## mitchellde (Jan 4, 2010)

Now that is what I as always told in the Cancer Center.  That it depends on where the lesion is located and not based on how deep the incision went.  For an excision of a skin lesion the incision must go to the depth of the suq tissue and you can be beyond that depth.  If you are only into the dermis and not through it then it is a shave.  If a skin lesion requires a deeper incision for removal then you may have a complex repair or a flap repair but it is still a skin excision.  If the anomaly is located in the subfascial area then it is coded using muscoloskeletal codes.  That is the way we were told so I agree with BFAITHFUL.


----------



## Hopp (Jan 4, 2010)

*Subcutaneous Tissue*

Thank you True Blue and BeFaithful - That does make sense to me and as I was taught. A cystic lesion is normally a integ.code unless documentation supports otherwise.      Deb, CPC


----------



## Williealawishes (Jan 4, 2010)

That's where I become so confused.  If the incision was made through the subcutaneous tissue and the cyst/lipoma/lesion was excised as a whole......
this could be in the integumentary system due to the location of the "lesion" not the dept of the removal?  How could you confirm that to the insurance company....the path reports are showing the lesion with underlying subcutaneous tissue attached.....
Now I really unsure.....


----------

