Review on Integumentary System CPT
Coding Guidelines
Dr. Shivani Prasad Khasnis, CPC
DISCLAIMER
This presentation is intended for Educational purpose only.
The information shared here has been reviewed completely
for accuracy, the instructor does not accept any responsibility
or liability with regards to errors or misinterpretation and it
should not be considered as legal advice.
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Agenda of the Presentation
Structure of Integumentary System
General Guidelines (10004 -10021)
Debridement (11000-11047)
Biopsy (11102 -11107)
Removal of Skin Tags (11200, 11201)
Shaving of Epidermal or Dermal Lesions (11300-11313)
Repairs (Closure) (12001-13160)
Adjacent Tissue Transfer or Rearrangement (14000-14350)
Skin Replacement Surgery (15002-15278)
Flaps (Skin and/or Deep Tissue) -(15570 -15777)
Burns, Local Treatment (16000-16036)
Destruction (17000 -17999)
Mohs Micrographic Surgery (17311 -17315)
Breast (19000-19499)
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STRUCTURE OF INTEGUMENTARY SYSTEM
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GENERAL GUIDELINES (10004 - 10021)
Fine Needle Aspiration (10004-10021) Fluid collection drainage by catheter (10030)
Without imaging guidance (10021, +10004)
Incision and drainage (10040 – 10180)
With image guidance (10005 -10012)
Ultrasound Guidance
Fluoroscopic Guidance
CT Guidance
MR Guidance
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DEBRIDEMENT (11000 -11047)
Debridement is a procedure that involves removal of infected, necrotic and non-viable tissue from a wound, so that healing
can take place with the intact viable tissue.
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DEBRIDEMENT (11000 -11047)
Three types of debridement Procedure:
Debridement Procedures on Infected and Necrotic
Skin of Genitalia, Perineum and/or abdominal wall.
(11000 – 11008)
Debridement Procedures for Open Fractures and
Dislocations (11010-11012)
All other debridement procedures (11042-11047)
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EXERCISE 1: DEBRIDEMENT
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EXERCISE 1 (RATIONALE): DEBRIDEMENT
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BIOPSY (11102 – 11107)
Biopsy is the the removal of cells or tissues for examination by a pathologist.
• Incisional Biopsy: a sample of the suspicious tissue is incised by sharp object for purposes of diagnosis.
• Tangential biopsy: a horizontal slice of epidermal tissues is removed with or without portions of the
underlying dermis for purposes of diagnosis.
• Punch biopsy : using a circular blade full-thickness skin plug is removed for purposes of diagnosis.
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BIOPSY (11102 – 11107)
Biopsies performed on different lesions or different sites on the same date of service may be reported separately, as they
are not considered components of other procedures.
During certain procedures in the integumentary system, such as excision, destruction or shave removals, the obtaining of
tissue is not considered a separate biopsy procedure and not reported separately.
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REMOVAL OF SKIN TAGS (11200, 11201)
Skin tags are painless, non-cancerous growths on the skin which are connected to the skin by a small, thin stalk called a
peduncle.
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SHAVING OF EPIDERMAL OR DERMAL LESIONS (11300 -11313)
Code each lesion separately based on Anatomic site and lesion diameter
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REPAIRS (CLOSURE) (12001 – 13160)
Simple (12001 – 12021) Intermediate (12031 – 12057) Complex (13100 – 13160)
Single layer/ one layer Layered closure More than layered closure
Superficial repair Two layer closure Scar revision
Repair through Extensive cleaning Debridement
epidermis, dermis or
subcutaneous tissue Single layer closure with Traumatic laceration/avulsion
without deeper structure contamination
Extensive undermining
Retention sutures
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REPAIRS (CLOSURE) (12001 – 13160)
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REPAIRS (CLOSURE) (12001 – 13160)
• Simple
• Intermediate
• Complex Same
Repair Anatomic site
Length of repair Add
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EXERCISE 2: REPAIRS (CLOSURE) (12001 – 13160)
Patient presents to the emergency department with multiple lacerations due to a knife fight at the local bar.
After examination it was determined these lacerations could be closed using local anesthesia. The areas were
prepped and draped in the usual sterile fashion. The surgeon documented the following closures:
i. 7.6 cm simple closure of the right forearm
ii. 5.7 cm intermediate closure of the right upper arm
iii. 4.7 cm complex closure of the right neck
iv. 10.3 cm intermediate closure of the upper chest; report CPT codes.
a. 13132, 12035-59, 12004-59
b. 13132, 12034-59, 12032-59, 12004-59 Type of repair Anatomic location Length
c. 13132, 12036-59 Complex Neck 4.7 cm
d. 13152, 12035-59, 12004-59 Intermediate Right upper arm (Extremities) 5.7cm
5.7 +10.3 = 16.0 cm
Intermediate Upper chest (Trunk) 10.3 cm
Simple Right Forearm 7.6 cm
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EXCISION OF LESION -11400 & 11600 SERIES
Local anesthesia
Excision
Repair
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EXCISION OF LESION -11400 & 11600 SERIES
Excision
Benign (11400-11471) Malignant (11600-11646)
Excised diameter = Greatest Lesion Diameter + 2 (Most Narrow Margin)
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EXERCISE 3 : EXCISION OF LESION
Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician marked the
area for excision. The lesion measured 0.9cm. The wound measuring 1.2 cm was closed in layers using 4-0
Monocryl and 5-0 Prolene. Pathology later reported the lesion to be a sebaceous cyst. What codes to be
reported?
a. 11401, L72.3
b. 12031, 11401-51, L72.3 Sebaceous cyst – benign cyst Closed in layers – intermediate
c. 13121,11401-51, L72.3 closure
d. 11402, L72.3
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ADJACENT TISSUE TRANSFER OR REARRAGEMENT
(14000 – 14350)
An adjacent tissue transfer, also known as a
rearrangement procedure is a medical procedure
wherein flat sections of healthy skin and
other tissues are transferred to the area adjacent to a
skin defect.
Key words – Z- plasty, W- plasty, V-Y-plasty, rotation flap,
random island flap or advancement flap
While coding focus on Size (primary and secondary
defects are added together) and Location of defect
(Recipient Site).
Excision of lesion that is repaired by adjacent tissue
transfer never code separately.
Simple Repair of donor site is bundled in ATT.
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SKIN REPLACEMENT SURGERY (15002-15278)
Surgical preparation
Skin replacement surgery
Autograft - graft taken from another area of the patient's Skin substitute grafts :
own body Allograft/homograft - a tissue graft from
a donor of the same species as the
Epidermal autograft recipient
Dermal autograft Xenograft - a graft of tissue taken from
Split-thickness autograft - graft that contains the a donor of one species and grafted into
epidermis and a portion of the dermis a recipient of another species
Full thickness graft - graft that consists of the
epidermis and entire dermis
Tissue cultured skin autograft - a tissue grown from
one's own skin cells for use in placing on the
person's own body
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SKIN REPLACEMENT SURGERY (15002-15278)
Code based on the location and size of defect area (recipient area)
Sum the surface area of all wounds from all anatomic sites that are grouped together in same code descriptor
Routine dressing, harvesting of graft and debridement are bundled
Code separately the repair of donor site requiring skin grafting and debridement only when gross contamination
requires prolonged cleansing.
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SKIN REPLACEMENT SURGERY (15002-15278)
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EXERCISE 4: SKIN REPLACEMENT SURGERY
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EXERCISE 4 (RATIONALE): SKIN REPLACEMENT SURGERY
Skin substitute graft
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FLAPS (SKIN AND/OR DEEP TISSUE) – (15570 – 15777)
Flap is a procedure where tissue is lifted from a donor site and moved to a recipient site with an intact blood supply.
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BURNS, LOCAL TREATMENT (16000 - 16036)
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DESTRUCTION (17000 -17999)
Premalignant lesion Benign lesion Malignant lesion
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EXERCISE 5 : DESTRUCTION (17000 -17999)
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EXERCISE 5 (RATIONALE): DESTRUCTION (17000 -17999)
1st lesion
Remaining
12 lesions
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MOHS MICROGRAPHIC SURGERY IMAGE
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MOHS MICROGRAPHIC SURGERY KEY POINTS
1. Confirm the surgeon and pathologist are the same
2. Identify location
3. How many stages?
4. How many blocks?
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MOHS MICROGRAPHIC SURGERY (17311 -17315)
Example:
Location – Feet
Stage I – 6 blocks 1 extra block
Stage II – 6 Blocks 1 extra blocks
Stage III – 7 Blocks 2 extra blocks
Answer:
17311
17312 x 2
17315 x 4
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MOHS MICROGRAPHIC SURGERY (17311 -17315)
If a surgeon removed more than one lesion on the
same anatomical site report the primary code more
than once
Example : If surgeon removed three lesions on leg,
then we need to code
17313
17313 17313 X 3
17313
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BREAST (19000 – 19499)
Biopsy
Percutaneous image guided breast biopsies Open incisional breast biopsy
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BREAST – MASTECTOMY (19300 – 19307)
Mastectomy partial (19301, 19302) – a portion of ipsilateral breast tissue is
removed. Eg: Lumpectomy, tylectomy, quadrantectomy, segmentectomy.
Mastectomy simple complete (19303) - total removal of ipsilateral breast tissue
with or without removal of skin and/or nipples
Mastectomy radical (19305-19307) - total removal of ipsilateral breast tissue,
including the nipple, pectoral muscle, axillary and internal mammary lymph nodes
To report bilateral procedures report modifier 50 with procedure codes.
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BREAST – REPAIR/RECONSTRUCTION
Breast reconstruction is performed to repair defects due to congenital anomaly or loss of breast tissue after a surgical
excision.
Updates in 2021 -
Deleted
19324 - Mammaplasty, augmentation; without prosthetic implant
19366 - Breast reconstruction with other technique.
Revision –
The code descriptions have been revised - the term mammary was replaced with the term breast and now includes language
to indicate if the breast implant insertion was performed on the same day or on a separate day as the mastectomy.
Detailed descriptions of the types of reconstruction used to repair defects using various techniques including latissimus dorsi
flap; free flap (e.g., DIEP, fTRAM, SIEA, and GAP flap); and single or bipedicle transverse rectus abdominis myocutaneous
(TRAM) flap.
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Thank You !!!
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