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ARCPC9491

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I'm studying for the CPC-H ...
I'm doing OP notes in "The Extra Step: Facility-Based Coding Practice" by Carol Buck

I think the book may be wrong with this:

Procedure: Excision of lesion of left chest wall with 5-mm proximal and distal margins and 2-mm lateral margins

My answer is 11400, 0.5 cm or less. The book is saying 11406, over 4.0 cm.

5-mm is .5 cm (mm/10=cm)

Is the book wrong?!?:confused: or what the heck am I doing wrong?
 
did you remember to add the margins?

Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter). The margins refer to the most narrow margin required to adequately excise the lesion, based on the physician's judgment. The measurement of lesion plus margin is made prior to excision.

Hope this helps
Good Luck :)
Mary
 
hmm, I'll have to look that up, I have that study guide also - but anyway, unless I'm reading the post wrong, I don't see the size of the lesion, I see 5-m margins and 2mm margins - so how big was the lesion? or am I reading this wrong?.... is the lesion supposed to be 5mm?


but - meant to say - your calculations are correct - so,... if the lesion "is" only 5mm - I'd say you found an error! nice catch! different cpt code with added margins though
 
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Alls the note says is:

Chest wall, prepped in Betadine solution and draped in sterile fashion. The lesion was anesthetized w/ a total of 3cc of 1% Xylocaine and 1:100,000 epinephrine. The lesion was excised elliptically with 5 mm proximal and distal margins and 2 mm lateral margins. Bleeding was electrocoagulated. Wound was closed with subcuticular 4-0 Monocryl in interrupted twists of 4-0 Monocrl. Steri strips applied. Patient tolerated procedure well.

SO you get a total of 10 mm (proximal and distal) plus 2 mm for lateral margins so it'd be

14 mm total? which would be 1.4 cm. I'm confusing myself.

Why am I going in circles with this!:)
 
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hmm.. I agree with what you come up with - is there a rationale (answer) - do they explain how they got the answer to the question? are we missing something? I've actually never heard the term "proximal and distal" margins used as in this scenario ...
 
Nope, it just says how to go to the index, and start at excision... nothing to do with sizes

I guess I will just settle for an error
 
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