I have read a lot of stuff about coding lipomas. My general surgeon often will remove multiple lipoma's from different parts of the body. Going by what I have read and been advised, we used the codes from the musculoskeletal system, which in one particular case wound up being a $40, 000.00 bill. This is using Ingenix fee analyzer at the 75th percentile for our area (Alaska). When I received another case from the surgeon for coding, there were six lipomas removed from thighs and forearms, all less than 3 cm in width, with simple closures. I sent a request to the surgeon to please document the depth of the incisions used, and (because of the pricing issue) what he deemed a fair fee to charge his patient. Ingenix would have been in excess of $16,000.00. He sent back saying that they were "superficial", but no actual depth, but that the charge should not be in excess of $4,000.00. That was almost to the dollar what it would have been using the integumentary system codes. So, which is right? The integumentary system codes have a 10 day follow-up period. These certainly would not have exceeded that. One follow-up visit to remove the sutures. The musculo-skeletal codes have a 90 day follow-up. Does anyone know where I can get a definitive answer to this puzzling situation. It is causing a great deal of contention in our office.