Wiki Lipoma Coding in a Dermatology practice vs General Surgery

[kheimerman]

I used to work for General Surgeons, so I am familiar with the soft tissue excision codes from the musculoskeletal part of the CPT book, but I am now coding for Dermatology, and am trying to determine at what depth, is it appropriate to stay in the benign lesion excision area versus when to hop on over to the 2xxxx M/S soft tissue codes. I know the M/S codes say subcutaneous or subfascial, and in the Dermatology practice I'm coding for we are excising these from the subcutaneous tissue, but from the documentation it sounds like it is superficial sub Q, and there is rarely a layered closure.. Will any payers allow the M/S codes to be used in a POS 11? When I coded for General Surgery, these patients were taken to an ASC to have these removed. At the Dermatology practice, they are removing them in our surgical suite with local anesthetic, but it is still POS 11. Our newest PA is also inquiring whether she can bill a first assist for lipoma surgery It is allowed on the M/S codes usually, but only on the larger 114xx codes. Thoughts anyone?