General Surgery Coding Alert
Integumentary Anatomy Primer
The outermost skin layer, the epidermis, varies in thickness from 0.05 mm (the eyelids) to 1.5 mm or more (for instance, in the soles of the feet), and is made up of five layers.
The stratum corneum, or surface layer (also called the -horny layer-), is comprised of dead, flat skin cells that shed regularly. Beneath this layer are (in order) the stratum lucidum, stratum granulosum, stratum spinosum and stratum basale.
The stratum basale (or basal layer), the innermost epidermal layer, is where new skin cells develop. The cells flatten and die as they migrate through the three middle epidermal layers (collectively called the squamous layer) to the stratum corneum.
The epidermis contains no blood vessels and is entirely dependent on the underlying dermis for nutrient delivery and waste disposal.
Between the epidermis and dermis lies the dermoepidermal junction, which is composed of two layers: the lamina lucida (closest to the epidermis) and lamina densa (closest to the dermis).
The dermis, which can range in thickness from 0.3 mm to 3.0 mm, likewise has several layers. These are called the papillary layer, which contains thin collagen fibers, and the reticular layer, which contains thicker collagen fibers arranged parallel to the skin's surface.
Both dermal layers contain elastic and reticular fibers, in addition to collagen, throughout. The dermis also contains blood vessels, lymph vessels, hair follicles and sweat glands. The dermis- primary function is to sustain and support the epidermis.
The subcutis, also called the subcutaneous layer, hypodermis or panniculus adiposus, is soft tissue that lies just under the skin. It consists of a network of collagen and fat cells, as well as nerves and blood vessels.
Important: The integumentary system does not extend into the muscle or bone below the subcutis. In most cases, the fascia surrounding the muscle forms the border between the integumentary system and the musculoskeletal system.
General Surgery Coding Alert
- Stop Undervaluing Excisions:
Get the Facts Here
Limiting yourself to superficial excisions will hurt coding accuracy and reimbursement
When your surgeon performs lesion [...] - Integumentary Anatomy Primer
Understanding surgeon documentation and assigning the appropriate excision is easier if you recognize the relevant [...] - Don't Forget S Codes for Private-Pay Lap Repairs
Medicare calls for unlisted-procedure code, but not all insurers agree
When reporting incisional hernia repairs using [...] - Take Closures With Excision on a Case-by-Case Basis
Sometimes repairs are bundled, but sometimes not
Just as with integumentary system excisions (such as 11400-11646), [...] - CCI Bundles Burn and Debridement Codes
Modifier 59 remains a possibility, but you need to know when to use it
The most [...] - You Be the Coder:
What's the Timing for 25?
Question: The surgeon sees a patient in consult-ation for cellulitis of the arm. The next [...] - READER QUESTIONS:
Global Re-Excision Needs 58
Question: One month after a needle excision, the surgeon performs a re-excision of breast cancer [...] - READER QUESTIONS:
Difficult Lap Appendectomy Calls for 22
Question: There are different codes for open appendectomy depending on whether the appendix is ruptured [...] - READER QUESTIONS:
Modifier Isn't the Issue for Wound Repair Closure
Question: When reporting a lesion excision (116xx) with a layered closure, do we have to [...] - READER QUESTIONS:
Consult Report Can Be Part of Shared Record
Question: Consult rules state that the consulting physician must send a written report of his [...]
