codedog
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When a lipoma is located in the superficial subcutaneous tissue, is it appropriate to code in the integumentary section or musculosketal section ?
PREOPERATIVE DIAGNOSIS: Left inguinal adenopathy.
POSTOPERATIVE DIAGNOSIS: Left inguinal masses.
PROCEDURE PERFORMED: Excisional biopsy of left inguinal soft tissue mass x2.
ANESTHESIA: MAC.
ESTIMATED BLOOD LOSS: Minimal.
CLINICAL HISTORY: with persistent left lower extremity edema of uncertain etiology. Patient has developed left inguinal adenopathy and by exam and a biopsy was requested by his hematologist. He has had a workup for DVT, which was negative.
PROCEDURE IN DETAIL: The patient was brought into the operating room and placed on the operating room table in a supine position. The left groin was prepped and draped in sterile fashion. The most dominant mass was between 1-2 cm inferior to his inguinal ligament. After injecting 8 cc of 1% lidocaine with epinephrine, a linear incision was made directly over the mass. Electrocautery was used to dissect through the subcutaneous tissue down to the mass, which grossly appeared consistent with about a 2 cm lipoma. This was completely excised. Hemostasis was achieved with electrocautery. The skin was closed with interrupted 3-0 nylon suture. Because it did not appear that this was a lymph node, biopsy of an additional mass was obtained over the inguinal ligament. A 5 cc of 1% lidocaine with epinephrine was injected for local anesthesia. A linear incision was made directly over a mass about 2 cm superior to this. Electrocautery was used to dissect through the subcutaneous tissue and in the superficial subcutaneous tissue, one of these masses was excised and it was also consistent with lipoma. This was transected; half was sent to culture and half was sent fresh to the pathologist lab. The wound was irrigated with normal saline, inspected, and found to be hemostatic. The skin was closed with interrupted 3-0 nylon suture. The patient tolerated the procedure well.
PREOPERATIVE DIAGNOSIS: Left inguinal adenopathy.
POSTOPERATIVE DIAGNOSIS: Left inguinal masses.
PROCEDURE PERFORMED: Excisional biopsy of left inguinal soft tissue mass x2.
ANESTHESIA: MAC.
ESTIMATED BLOOD LOSS: Minimal.
CLINICAL HISTORY: with persistent left lower extremity edema of uncertain etiology. Patient has developed left inguinal adenopathy and by exam and a biopsy was requested by his hematologist. He has had a workup for DVT, which was negative.
PROCEDURE IN DETAIL: The patient was brought into the operating room and placed on the operating room table in a supine position. The left groin was prepped and draped in sterile fashion. The most dominant mass was between 1-2 cm inferior to his inguinal ligament. After injecting 8 cc of 1% lidocaine with epinephrine, a linear incision was made directly over the mass. Electrocautery was used to dissect through the subcutaneous tissue down to the mass, which grossly appeared consistent with about a 2 cm lipoma. This was completely excised. Hemostasis was achieved with electrocautery. The skin was closed with interrupted 3-0 nylon suture. Because it did not appear that this was a lymph node, biopsy of an additional mass was obtained over the inguinal ligament. A 5 cc of 1% lidocaine with epinephrine was injected for local anesthesia. A linear incision was made directly over a mass about 2 cm superior to this. Electrocautery was used to dissect through the subcutaneous tissue and in the superficial subcutaneous tissue, one of these masses was excised and it was also consistent with lipoma. This was transected; half was sent to culture and half was sent fresh to the pathologist lab. The wound was irrigated with normal saline, inspected, and found to be hemostatic. The skin was closed with interrupted 3-0 nylon suture. The patient tolerated the procedure well.
