Wiki Skin Lesion

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KaylaRieken

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Help with Coding....

Wedge excision of a 2.5 cm non healing penile lesion with wound closure

I began with penile block with Marcaine and then I used a Marcaine-lidocaine mixture at the skin after planning an elliptical incision. The area of concern was just on the dorsum proximal to the corona of the glans penis. I made the incision with a blade and then used Bovie electrocautery to excise the lesion. I then closed the deep skin with 4-0 Vicryl in an interrupted fashion and then closed the superficial dermis with interrupted 4-0 chromic. Bacitracin ointment was applied and this conclude the procedure, which the patient tolerated without difficult.

Pathology came back as nonspecific ulcer with subjacent fibrosis and dense lymphoplasmacytic inflammation. No dysplasia or malignancy identified.

I think it would be 11423, but would I add 12041 because of the layered closure? I code for urology and when they remove skin lesions, it's confusing for me. Also for diagnoses D29.0 or D49.2?
 
There is no edit for 11423 and 12041 so those can be billed together. For the dx, in my area, the LCD states that D29.0 is a covered diagnosis but D49.2 is not a payable dx so I would use D29.0 as the first listed dx as they are both applicable.
 
I would agree with the CPT coding, but this should not be coded as a benign neoplasm based on the pathology documentation you've provided - there is no neoplastic tissue identified here. Neither D49.2 nor D29.0 are supported by this. At first look, I might suggest N18.5 for the ulcer/inflammation and/or L90.5 for the fibrosis.
 
Last edited:
thomas7331 said:
I would agree with the CPT coding, but this should not be coded as a benign neoplasm based on the pathology documentation you've provided - there is no neoplastic tissue identified here. Neither D49.2 nor D29.0 are supported by this. At first look, I might suggest N18.5 for the ulcer/inflammation and/or L90.5 for the fibrosis.
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Should have looked further into the diagnoses. L90.5 and N48.5, I agree. (I think you just mistyped N18.5 :))
 
Great, thanks. I did also have N48.5 written down, but I didn't see that as one of the payable diagnosis codes so I was unsure about it. I will look again. (Like i said dermatology is confusing for me) :)
 
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