Integumentary System Individual Exercises

1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a
particularly uncooperative established patient. How should this procedure be reported?

10060. Ideally the coder should obtain additional documentation indicating

whether the procedure was simple or complicated. In the absence of such
documentation, the coder will have to assume that the procedure was simple and
report using 10060.

2. A diabetic patient presents with infected skin on his left leg. The vascular surgeon decides
to treat the infection by debridement. Two percent of the body surface area is debrided.
How should this procedure be reported?

11000

3. A patient presents to the emergency department with an open arm fracture. The physician
debrided the injury site, removed some loose gravel from the site and then referred the
patient out for fracture care. The ED physician’s documentation states that the depth of the
debridement was down to and including the bone. How should the debridement be
reported?

11012 This was a debridement associated with an open fracture.

4. How would the removal of the gravel in the above question be reported?

Bundled

5. A patient presented with severe decubitus ulcers of the upper back region (measuring 25 sq
cm) and the right upper arm (measuring 15 sq cm). The surgeon performed a debridement
of the subcutaneous tissue of the upper back ulcer. During the same surgical session, the
surgeon also performed a debridement of the muscle of the right upper arm ulcer. The
physician informed the patient (and documented) that another debridement might be
required in the future. The applicable payer has a 90 day global period for this procedure.
How would this initial debridement session (including both the upper back and right upper
arm debridement) be reported?

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permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American
Medical Association.
 11042, 11045, 11043-59 The -59 is used because these were separate sites.
Debridement surface areas may not be combined if they are of different depths
even if performed during the same session.

6. Two months later, the patient in the above question returns to the hospital for another
debridement on his right upper arm ulcer (measuring 15 sq cm). The physician performs
another debridement on the right upper arm involving debridement down to and including
the bone. How should these services be reported?

11044-58 This was a more extensive procedure during the post-op period that was
not due to a complication of the prior surgery.

7. Patient presents with a stage II pressure ulcer (measuring 10 sq cm) over the right hip. The
physician performs a sharp debridement of the skin but no subcutaneous tissue. How
should the debridement be reported?

97597 See the instructional note under CPT code 11042 that debridement of the
skin only should be assigned with codes 97597-97598.

8. Mr. Smith presents to a general surgeon’s office to have a 1 cm excised diameter benign
facial lesion, a 2 cm excised diameter benign arm lesion and a 4 cm excised diameter
benign hand lesion excised. How should these services be reported?

11424, 11441-59, 11402-59

9. The above lesion excisions required simple closure by the surgeon. How should the closure
be reported?

Simple closure is bundled

10. A physician excised a 2 cm excised diameter benign leg lesion and a 4 cm excised diameter
benign back lesion. The excision of the back lesion resulted in a 5 cm defect. During the
same session, the physician performed a complex closure of the defect on the back. How
should these services be reported?

11404, 13101-51, 11402-59

11. A physician excises a 2.0 cm malignant neck lesion. In order to completely excise the
lesion, the physician also removed an additional .4 cm total skin margin. This was the

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permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American
Medical Association.
 narrowest margin required to adequately excise the lesion. How should these services be
reported?

11623

12. A 4.1 cm excised diameter malignant lesion of the trunk was excised resulting in a defect
that required repair by adjacent tissue transfer. Following the excision, the physician
performed an adjacent tissue transfer to repair a 9.0 sq. cm. defect (including both the
primary and secondary defects) on the patient’s trunk. How should these services be
reported?

14000 The lesion excision is bundled. Therefore, code 11606 would not be
separately reported. Per CPT Assistant, January 2006, “the adjacent tissue
transfer or rearrangment procedures (local flaps), as described by codes 14000-
14350, are for the “excision (including lesion).” Therefore, the excision of the
lesion, whether benign or malignant, is included with codes 14000-14350 and
should not be reported separately.”

13. A burn patient presents for placement of an autograft. A 50 sq cm epidermal autograft was
harvested from the patient’s trunk. Prior to application, an incisional release of the scar
contracture was performed to prepare the recipient site on the patient’s neck. The 50 sq cm
epidermal autograft was then surgically fixated on the patient’s neck to cover the burn site.
How should these services be reported?

15115, 15004-51. Codes are assigned based on the recipient site not the grafting
site therefore code 15110 would not be appropriate. A separate code is assigned
for the preparation of the recipient site, per the guidelines. A contracture is a fixed
tightening of muscle, tendons, ligaments, or skin limiting movement. CPT Code
15040 would not be appropriate since this code can only be used in conjunction
with the tissue-cultured epidermal autografts. There is no harvesting code for
other autografts or any other type of graft.

14. Mrs. Jones presents to her gynecologist because she has felt changes in her right breast
during her monthly self-examinations. The physician aspirates, by puncture, two separate
breast cysts. How should these services be reported?

19000[-RT], 19001[-RT]

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permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American
Medical Association.
 Integumentary Operative Report
Excisional Breast Biopsy

Preoperative Diagnosis: Left breast calcifications.

Postoperative Diagnosis: Same.

Anesthesia: Monitored anesthesia care.

Procedure: Excisional Breast Biopsy

Description of Procedure:

The radiologist provided wire localization and mammography, placing two wires, one tracking
to the 12 o’clock position of the left breast and one toward the 2 o’clock position. The
anesthesiologist administered IV sedation.

The breast was prepped and draped in the usual sterile fashion. 1% Xylocaine was infiltrated
for local anesthesia. An incision was made in the upper outer quadrant from the 12 o’clock to
the 2 o’clock position slightly anterior to the wire exit point. The subcutaneous and breast
tissues were divided using cautery until the wires were encountered within the breast
parenchyma and brought up through the incision. The wires were then tracked individually to
the stiffened portions. The tissue was then clamped with an Allis clamp and dissected using
cautery and sharp dissection to excise both lesions. The specimens were sent separately to
pathology. Note that the 12 o’clock position specimen was deep in the 12 o’clock location and
the more lateral specimen was in the 2 o’clock position quite lateral and deep to the axillary
tail region. Cautery was used to maintain hemostasis. The deep tissues were approximated
with 3-0 Vicryl interrupted suture. The skin was closed with a running subcuticular 4-0 Vicryl
suture. Steri-Strips and sterile dressings were applied. Specimen radiographs (interpreted by
the radiologist) revealed that each of the areas of concern has been fully excised. The
specimens were sent for permanent pathology. The patient was discharged to the recovery
room in stable condition.

How should the surgeon’s professional services be reported?

Answer:

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permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American
Medical Association.
 19125[-LT], 19126[-LT] The placement of the localization wire (see
19290) and associated radiologic services are not reported by the surgeon
because those service were provided by the radiologist.

Although not entirely clear from CPT, the wound closure would
probably not be reported separately. Under the general guidelines for
excision of lesions, a layered closure is separately reportable. However, there
is no similar guideline in the breast subsection. Consequently, it would
arguably not be appropriate to report closure of the breast separately.

Copyright 2000-2011 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express written
permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American
Medical Association.