# subcutaneous vs subfascial removal ?



## BFAITHFUL (Jan 25, 2012)

Not sure between codes for subq or subfascial removals of face & back. 21012/21014  & between 21931 vs 21933
He says he went thru skin and subq tissue but I'm just not sure if that's enough?

OPERATIVE FINDINGS:
1.	2 x 2 cm fatty tumor right face.
2.	6 x 6 cm fatty tumor right back.

BRIEF CLINICAL HISTORY:
The patient is a 72 year old female who has a 2 x 2 cm mass on the right face, just in front and inferior to the ear, and a 6 x 6 cm tumor on the right lateral back, just posterior to the flank, but inferior to the scapula.

DESCRIPTION OF PROCEDURE:
The back is approached first.  The skin overlying the marked out lesion is infiltrated with lidocaine.  A transverse incision is made. When we come down through skin and subcutaneous tissue, an encapsulated fatty tumor, measuring approximately 6 x 6 cm, is excised.  We now irrigate and dry, and oozing is stopped with a Bovie cautery.  We infiltrate with Marcaine deeply.  The wound is closed in layers using 3 0 Vicryl, deeply, in a continuous fashion, and a second layer of 3 0 Vicryl through the subcutaneous more superficially, and then finally, the skin is closed with a running 4 0 Monocryl subcuticularly.  Benzoin and Steri Strips are placed followed by Telfa Bioclusive.  

At this time, attention is turned to the right face.  The facial lesion is prepared with Betadine.  It is marked out with a sterile marking pen.  It is draped out sterilely.  The skin is infiltrated with lidocaine 1%.  A transverse incision is made, and now after coming through skin and subcutaneous tissue, an encapsulated fatty tumor is dissected away from the surrounding tissue, and any oozing is stopped with a Bovie cautery.  The wound is now closed with a running 5 0 nylon.  Telfa and Bioclusive is placed.


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## BFAITHFUL (Jan 26, 2012)

any takers on this one please???>


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## jdemar (Jan 26, 2012)

I would go with the subcu., the note doesn't state the physician went to the fascia/intramuscular.

Subcu. is fat to the outermostfascial layer;    Deep is down deep within the soft tissue, such as into the fascial layer or within the muscle.


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## BFAITHFUL (Jan 26, 2012)

thank you


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