Wiki 114xx vs 2xxxx series codes

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LaSeille

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Need help please! When the surgeon dictates an OP report stating he did a "wide, deep excision of a mass" and dictates no size, etc., and his diagnosis is dictated as "deep mass of _________", and the Pathology Report states that the "mass" is an inclusion cyst and codes the dx as 706.2, and that the size of the cyst is 4 cm.... How would you code the procedure code? Would you use the 114xx series codes or would you use the 2xxxx series codes (exc of tumor of subcutan/subfasc) ??

Thanks!
 
mbe459 said:
If the path comes back with a dx of 706.2 you have to use the 114xx codes.

Michelle
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Your diagnosis is coded based on the Pathology report.

Your procedure is coded based on the Operative note.


Any time a lesion size in not noted, you can defer to the code that reflects the smallest size. However, the prudent thing to do is query the physician.
 
Reply to 114xxxx vs 2xxxx codes

Check with your Doc - He might have closed the wound
with a layered closure then you would be able to code
the excision with the appropriated exc. code from the integ.
codes along with the layered closure (12031-12057)
Deb, CPC
 
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