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27 Cards in this Set

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Integumentary System Codes
Provide codes for invasive procedures by physician of any speciality type.
Codes encompass procedures performed on:
- skin
- subcutaneous layers
- nails
- breast
Deep layers of the skin are coded how?
-coding convention is to go to respective body system for the correct code.
Integumentary System Terminology guides:

Complicated
Means:
-infection occurred
- treatment delayed
- procedure took longer than usual
*note: make sure to check note section because "complicated" can have different meanings
Integumentary System Terminology guides:

Excisions of Lesions:
Clarification
- Lesions are identified by size
- Lesions are identified by morphology
- The size should be noted by physician
-the final authority to check for size of lesions is the pathology report there can be a differences between the size of the tissue removed or excised vs the actual size of lesion.
Coding Excisions of Lesions
Check the number of lesions which are included in the code.

-51 modifier may or may not need to be applied check description of the code closely.
Shaving:
Means no closure is needed. The skin is simply shaved away.
Excision
includes SIMPLE CLOSURE of the skin post excision of a lesion.
- If the closure is complex read and be guided by the description of the closure to assign the appropriate code
Destruction
By any method ie: freezing, burning, chemicals ect.
- I always remember to go to this section if there is nothing left of the lesion. No pathology report to look at, with exception of the physician taking a biopsy prior to the destruction of the lesion
integumentary Codes for Malignant and Benign Lesions
There are separate codes for benign and malignant lesions
- always consult the pathology report for confirmation prior to assigning codes
- Pathology report is the final owrkd even if it contradicts the physician
Re-excision of Malignant Lesion Site
- Code to excision of malignant lesion
- Check with the pathology report
Wound Repair Coding - 3 Factors
- length of the wound in centimeters
- complexity of repair
- the site of the wound repair
Simple Repair
-superficial wound, epidermis, dermis and subcutaneous tissue
- requires only ONE-LAYER suturing
Intermediate Repair

AKA: Layered Closure
- closure of one or more subcutaneous tissue and superficial fascia in addition to skin closure.
Complex Repair
- Involves complicated wound closure including revision, debridement, extensive undermining and more than one layered closure.
Dermabond (skin glue)
Is considered a suture
Sequencing Repair Codes
Most complex repair code first
- secondary procedures will be reported with a modifier of -51
- this modifier results is a % decrease in the reimbursement received
What is considered part of wound repair
- ligation, exploration, debridement (with the exception of extensive debridement for grossly contaminated tissue)
What questions to ask when coding repairs?
- What is the length of wound in cm?
- What is the complexity of repair?
- What is site of repair?
- are there any repairs that can be combined?
How to Find Repair Codes
- Look under repair....wound....then type of closure
Skin Grafts
- Need to know the recipient site
and donor site
Types of Skin Grafts

Adjacent Tissue Transfer / Rearrangement
- Z-plasty, W-plasty, V-Y plasty, rotation flaps, and advancement flaps
- Moves the tissue from one area to an ADJACENT area and leaves one side intact
- coded according to size of recipient site/ square cm
-simple repair of donor site is included
-Excision of a lesion is included in code
-How to find look under skin in the INDEX
Types of Skin Grafts

Free Skin Grafts Types
- Split thickness - epidermis and part of the dermis
- Full thickness - epidermis and all of the dermis
Types of Skin Grafts

Free Skin Grafts Types
Skin is freed completely from donor site
Coded according to recipient site and size
- additional code if donor site requires grafting
- simple repair is included in the code
CPT Code 15000 Preparing the recipient site
- Does not need a modifier as per the code description
Flaps
-Develop donor site at location far away from the recipient site
-May have to be accomplished in stages
-Delayed graft
-portion of the skin is lifted and separated from tissue below, bt it still stays connected to blood vessels on one end
Repairs
Integumentary System
Some Items Reported Separately
- Blood Vessels
- Nerves
- Tendons