KBean2018
Guru
I am trying to make sure I select the right code based on lesion size. I’ve read that we go based on what the doctor documents prior to excision and I also read we go based on path report. So im a little confused. Thanks in advance!
11400-11404 code range
Path report-
the container and labeled "right areola nevus" is an ellipse of skin,
1.1 x 0.5 x 0.2 cm, transversely sectioned and tips submitted in
A1, remainder in toto through to A2. On the surface is a 0.6 cm
flat hyperpigmented lesion.( BENIGN PIGMENTED JUNCTIONAL MELANOCYTIC NEVUS)
The container and labeled "sternum lesion" is an ellipse of skin, 1.3
x 0.7 x 0.3 cm, transversely sectioned and tips submitted in B1,
remainder in toto through to B2. On the surface is a 0.5 cm pink
slightly raised lesion (BASAL CELL CARCINOMA)
The container and labeled "subcutaneous lesion of right chest wall"
is a 0.8 cm in greatest dimension disrupted grumous filled cyst,
with attached tan skin measuring 1.3 x 0.4 cm. Representative (
EPIDERMAL INCLUSION CYST)
BREAST TISSUE REARRANGEMENT left breast
EXCISION NEVUS RIGHT AREOLA EXCISION SKIN LESIONs STERNUM and right chest wall
Left breast mass [N63.20]
Benign skin lesion of sternum [L98.9]
Nevus of female breast [D22.5]
He began the left breast mass excision by excising an ellipse along what I am to be her new IMF. I used her right IMF as a template to design her new left IMF. It was significantly lower and more medial than her current left IMF which had been distorted superiorly and laterally by a large 4 x 3 cm bluish medial left inframammary fold mass. Please see his dictation for the excision portion of the procedure.
While he was working on the left side I began on the right side. With a scalpel I excised all 3 lesions previously discussed .These included a 1 cm irregular brown pigmented nevus of her right areola halfway between the nipple base and area lower margin. The length of the ellipse excised measured 2 cm to include 5 mm margin. In addition I excised a 6 mm dry crusty nonpigmented raised lesion of the sternum to the right of midline. A 2.5 cm ellipse of skin was excised to include a 5 mm margin. Finally I excised the 1 cm round raised subcutaneous lesion of the right upper chest wall with a 3 cm ellipse of skin along the midclavicular line. They were all sent to pathology for examination. Hemostasis was achieved using electrocautery. All 3 areas were injected with a total of 20 cc of quarter percent Marcaine with epinephrine for anesthesia. The lesions were irrigated with normal saline. They were closed in layers using 4-0 Polysorb in the dermis and 4-0 Biosyn the subcuticular layer.
Once Dr. completed the left breast mass excision I mobilized the left breast tissue off the pectoralis. Care was taken to maintain the superior medial and lateral blood supply to the breast tissue and nipple areolar complex. I then incised the left breast IMF to allow it to descend approximately 1.5 cm to match the contralateral side. I tacked the skin down using 2-0 Polysorb sutures to re-create the new inframammary fold. Then using 2-0 Polysorb interrupted figure-of-eight sutures I medialized the breast tissue to fill the defect left after excising the left breast mass. The patient was sat upright 90 degrees to assess the symmetry and new contour of the breast. A small amount of additional redundant skin along the new IMF was resected using the tailor tacking technique. Patient was returned to prone position. The left breast pocket was irrigated with normal saline. Hemostasis was achieved using cautery. And is 30 cc of quarter percent Marcaine with epinephrine was injected for local anesthesia. The incision was then closed in layers using 3-0 Polysorb in the dermis and 4-0 Biosyn subcuticular layer. Dermabond prineo was placed over all of the incisions. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
11400-11404 code range
Path report-
the container and labeled "right areola nevus" is an ellipse of skin,
1.1 x 0.5 x 0.2 cm, transversely sectioned and tips submitted in
A1, remainder in toto through to A2. On the surface is a 0.6 cm
flat hyperpigmented lesion.( BENIGN PIGMENTED JUNCTIONAL MELANOCYTIC NEVUS)
The container and labeled "sternum lesion" is an ellipse of skin, 1.3
x 0.7 x 0.3 cm, transversely sectioned and tips submitted in B1,
remainder in toto through to B2. On the surface is a 0.5 cm pink
slightly raised lesion (BASAL CELL CARCINOMA)
The container and labeled "subcutaneous lesion of right chest wall"
is a 0.8 cm in greatest dimension disrupted grumous filled cyst,
with attached tan skin measuring 1.3 x 0.4 cm. Representative (
EPIDERMAL INCLUSION CYST)
BREAST TISSUE REARRANGEMENT left breast
EXCISION NEVUS RIGHT AREOLA EXCISION SKIN LESIONs STERNUM and right chest wall
Left breast mass [N63.20]
Benign skin lesion of sternum [L98.9]
Nevus of female breast [D22.5]
He began the left breast mass excision by excising an ellipse along what I am to be her new IMF. I used her right IMF as a template to design her new left IMF. It was significantly lower and more medial than her current left IMF which had been distorted superiorly and laterally by a large 4 x 3 cm bluish medial left inframammary fold mass. Please see his dictation for the excision portion of the procedure.
While he was working on the left side I began on the right side. With a scalpel I excised all 3 lesions previously discussed .These included a 1 cm irregular brown pigmented nevus of her right areola halfway between the nipple base and area lower margin. The length of the ellipse excised measured 2 cm to include 5 mm margin. In addition I excised a 6 mm dry crusty nonpigmented raised lesion of the sternum to the right of midline. A 2.5 cm ellipse of skin was excised to include a 5 mm margin. Finally I excised the 1 cm round raised subcutaneous lesion of the right upper chest wall with a 3 cm ellipse of skin along the midclavicular line. They were all sent to pathology for examination. Hemostasis was achieved using electrocautery. All 3 areas were injected with a total of 20 cc of quarter percent Marcaine with epinephrine for anesthesia. The lesions were irrigated with normal saline. They were closed in layers using 4-0 Polysorb in the dermis and 4-0 Biosyn the subcuticular layer.
Once Dr. completed the left breast mass excision I mobilized the left breast tissue off the pectoralis. Care was taken to maintain the superior medial and lateral blood supply to the breast tissue and nipple areolar complex. I then incised the left breast IMF to allow it to descend approximately 1.5 cm to match the contralateral side. I tacked the skin down using 2-0 Polysorb sutures to re-create the new inframammary fold. Then using 2-0 Polysorb interrupted figure-of-eight sutures I medialized the breast tissue to fill the defect left after excising the left breast mass. The patient was sat upright 90 degrees to assess the symmetry and new contour of the breast. A small amount of additional redundant skin along the new IMF was resected using the tailor tacking technique. Patient was returned to prone position. The left breast pocket was irrigated with normal saline. Hemostasis was achieved using cautery. And is 30 cc of quarter percent Marcaine with epinephrine was injected for local anesthesia. The incision was then closed in layers using 3-0 Polysorb in the dermis and 4-0 Biosyn subcuticular layer. Dermabond prineo was placed over all of the incisions. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.