You can post a question only up to 7 days from the date of the webinar.
You can continue to post comments and stay informed, compliant, and profitable.
Close
This session has expired.
Register for our upcoming webinars & continue to get coding, compliance & reimbursement updates.
Close

Post

Vote
0
2 Followers Follow
Posted By Maria on 11-19-2018, 12:55:50 in Ob-Gyn
Hey Melanie,

Help please with CPT code.

I have the hardest time with the excisions codes.

How do you determine the size of the lesion(s)?

On Op report I see nothing to indicate the excision size.

The path report has 2 biopsies.

Specimen sizes are given in path report by o'clock positions.

The dr is wanting to bill 11626.

I am not sure where he came up with that size.

Thanks for any help in making this clearer to me.

Report:
INDICATIONS:
47 yo with VIN 3 and positive margin here for re-excision
 
FINDINGS:
Healing area of prior surgery - re-excision with larger margin done
 
SPECIMEN:
Portion of vulva
 
 
PROCEDURE:
After assuring informed consent the patient was taken back to the operating suite and induction of anesthesia was done. The patient was placed in the modified dorsal lithotomy position in Allen stirrups then prepped and draped in the normal sterile fashion. The vulvar lesion was identified and marked with a pen. A 15 blade scalpel was used to excise this vulvar lesion. The bovie was used to complete the excision and obtain hemostasis. Deep sutures of 2-0 vicryl were placed. The skin was reapproximated with 3-0 vicryl in interrupted fashion. Excellent hemostasis was noted. The patient tolerated the procedure well. Sponge, lap, needle and instrument counts were correct x 2. The patient went to the recovery room in stable condition.

PATH:


Final Pathologic Diagnosis:
A&B.  Vulvar lesion resection, lesion stitch at 3 o'clock and lesion
stitch at 9 o'clock:
          Negative for residual vulvar intraepithelial neoplasia.  
Procedure:
Re excision vulvar dysplasia

Specimen(s) Received:
A: Vulvar lesion stitch at 3 o'clock
B: Vulvar lesion stitch at 9 o'clock



Microscopic Description:
A.  The biopsy contains a portion of ulcerated skin partially replaced by
granulation tissue and scar tissue and having a number of sutures present
with foreign body reaction.  No residual dysplasia is identified.

B.  The biopsy contains similar ulcerated mucosa largely replaced by
granulation tissue and scar tissue and have a focal foreign body reaction
consistent with prior surgery.   No residual dysplasia is present.

Gross Description:
A.  Container A labeled vulvar lesion, stitch at 3 o'clock.  The specimen
is an ovoid portion of soft tissue with a single stitch placed at the 3
o'clock position of the specimen.  Using this orientation, the specimen is
2.2 cm from 3 to 9 o'clock tips, 1.3 cm from 6 to 12 o'clock broad
margins.  The margin extending from 9, 12 to 3 o'clock is inked blue.  The
margin extending from 3, 6 to 9 o'clock is inked orange.  The specimen is
serially sectioned from 9 to 3 o'clock tips and submitted entirely in four
cassettes, submitted sequentially progressing from 9 o'clock tip in block
number 1 to 3 o'clock tip in block number 4.  

B.  Part B labeled vulvar lesion, stitch at 9 o'clock.  The specimen is an
ovoid portion of tan soft tissue with a single stitch placed at the 9
o'clock tip.  No additional orientation is received.  The specimen
measures 1.8 cm from 9 to 3 o'clock tips, 1 cm from 6 to 9 o'clock broad
margins.   The margin extending from 9, 12 to 3 o'clock is inked blue.  The
margin extending from 3, 6 to 9 o'clock position is inked orange.  The
specimen is serially sectioned along the short-axis and submitted entirely
in four cassettes, submitted sequentially progressing from 9 o'clock tip
in block 1 to 3 o'clock tip in block 4.  




Comments (1)
Posted By Melanie Witt on 12-06-2018, 14:14:01
There are a couple of issues here. First, the path report comes back negative for cancer so 11626 would not apply. Also while he took a biopsy of the 2 areas, there is no evidence by the size that these were wide margins as the the path report shows the size for lesion A as 2.2 cm X 1.3 cm and lesion B as 1.8 cm X 1.0 cm. You find the code that represents the widest diameter for each lesion per CPT to get the correct code which would make it 2 lesions removed - one an 11422 and the other 11423 as they were distinct lesions per the path report.
Do you want to remove this attachment from this post?
Yes No
Do you want to add this specialty to your selected specialty list?
Yes No
To comment, please register for any of our webinars. Click here to register for our upcoming webinars.
Close
This comment will be permanently deleted. Do you still want to continue?
Yes No
Do you want to remove this comment from this discussion?
Yes No
Do you want to block this user from participating in this discussion?
Yes No
Do you want to allow this user to participate in this discussion?
Yes No
This post will not be available for further discussion/comments if deleted. Do you still want to continue?
Yes No