Cpt-4 Coding Integumentary System - Chapter 13

Front 1

Integumentary System Codes

Back 1

Provide codes for invasive procedures by physician of any speciality type.

Front 2

Codes encompass procedures performed on:

Back 2

- skin
- subcutaneous layers
- nails
- breast

Front 3

Deep layers of the skin are coded how?

Back 3

-coding convention is to go to respective body system for the correct code.

Front 4

Integumentary System Terminology guides:

Complicated

Back 4

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

Front 5

Integumentary System Terminology guides:

Excisions of Lesions:

Back 5

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.

Front 6

Coding Excisions of Lesions

Back 6

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.

Front 7

Shaving:

Back 7

Means no closure is needed. The skin is simply shaved away.

Front 8

Excision

Back 8

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

Front 9

Destruction

Back 9

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

Front 10

integumentary Codes for Malignant and Benign Lesions

Back 10

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

Front 11

Re-excision of Malignant Lesion Site

Back 11

- Code to excision of malignant lesion
- Check with the pathology report

Front 12

Wound Repair Coding - 3 Factors

Back 12

- length of the wound in centimeters
- complexity of repair
- the site of the wound repair

Front 13

Simple Repair

Back 13

-superficial wound, epidermis, dermis and subcutaneous tissue
- requires only ONE-LAYER suturing

Front 14

Intermediate Repair

AKA: Layered Closure

Back 14

- closure of one or more subcutaneous tissue and superficial fascia in addition to skin closure.

Front 15

Complex Repair

Back 15

- Involves complicated wound closure including revision, debridement, extensive undermining and more than one layered closure.

Front 16

Dermabond (skin glue)

Back 16

Is considered a suture

Front 17

Sequencing Repair Codes

Back 17

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

Front 18

What is considered part of wound repair

Back 18

- ligation, exploration, debridement (with the exception of extensive debridement for grossly contaminated tissue)

Front 19

What questions to ask when coding repairs?

Back 19

- 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?

Front 20

How to Find Repair Codes

Back 20

- Look under repair....wound....then type of closure

Front 21

Skin Grafts

Back 21

- Need to know the recipient site
and donor site

Front 22

Types of Skin Grafts

Adjacent Tissue Transfer / Rearrangement

Back 22

- 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

Front 23

Types of Skin Grafts

Free Skin Grafts Types

Back 23

- Split thickness - epidermis and part of the dermis
- Full thickness - epidermis and all of the dermis

Front 24

Types of Skin Grafts

Free Skin Grafts Types

Back 24

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

Front 25

CPT Code 15000 Preparing the recipient site

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- Does not need a modifier as per the code description

Front 26

Flaps

Back 26

-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

Front 27

Repairs
Integumentary System
Some Items Reported Separately

Back 27

- Blood Vessels
- Nerves
- Tendons