AAPC - American Academy of Professional Coders Integumentary System Procedures Questions and Answers — Questions and Answers
Question 1: A patient undergoes a full-thickness excisional biopsy of a 1.2 cm lesion on the neck. The operative report states that the surgeon performed a layered closure of the 1.5 cm resulting defect. How should this be coded?
- Code for the excisional biopsy only, as simple closure is included.
- Code for the excisional biopsy and a simple repair.
- Code for the excisional biopsy and an intermediate repair. (Correct answer)
- Code for a punch biopsy and a layered closure.
Correct answer: Code for the excisional biopsy and an intermediate repair.
CPT guidelines for lesion excision (codes 11400-11646) state that simple closure is included in the excision code. However, intermediate and complex repairs can be reported separately. A layered closure is defined as an intermediate repair. Therefore, both the excision of the lesion and the intermediate repair should be coded.
Question 2: A physician performs Mohs micrographic surgery on a patient's nose for a recurrent basal cell carcinoma. The first stage involves the removal of 5 tissue blocks. The second stage involves the removal of 3 additional tissue blocks. Which CPT codes should be reported for this procedure?
- 17311, 17312 (Correct answer)
- 17313, 17314
- 17311, 17312, 17315
- 17311 x 2
Correct answer: 17311, 17312
CPT code 17311 is used for the first stage of Mohs surgery on the head, neck, hands, feet, or genitalia, including up to 5 tissue blocks. CPT code 17312 is an add-on code for each additional stage, up to 5 tissue blocks, in the same anatomic areas. Since the procedure was on the nose (head) and involved two stages within the block limits, 17311 and 17312 are the correct codes.
Question 3: A patient has a 4.5 cm laceration on the trunk and a 3.2 cm laceration on the arm. Both wounds required a layered closure after extensive cleaning due to heavy contamination with particulate matter. How would you code the repairs?
- Report two separate intermediate repair codes based on their individual lengths and locations.
- Report one simple repair code for the total length of both lacerations.
- Report one complex repair code because of the heavy contamination.
- Report one intermediate repair code, summing the lengths of both lacerations because they are in the same anatomical group and of the same complexity. (Correct answer)
Correct answer: Report one intermediate repair code, summing the lengths of both lacerations because they are in the same anatomical group and of the same complexity.
According to CPT guidelines, when multiple wounds of the same complexity are repaired and are in locations that fall under the same code descriptor, their lengths should be summed together. The trunk and arms are grouped together for intermediate repairs (12031-12037). The total length is 4.5 cm + 3.2 cm = 7.7 cm. The correct code would be for an intermediate repair of the trunk/arms/legs measuring 7.7 cm.
Question 4: Which of the following procedures is defined as the full-thickness removal of a lesion, including margins, where the code selection is based on the lesion's diameter plus the narrowest margins?
- Tangential biopsy
- Shave removal
- Excision (Correct answer)
- Destruction
Correct answer: Excision
CPT defines an excision as the full-thickness removal of a lesion, including margins. The code selection for excisions (11400-11646) is determined by the excised diameter, which is the lesion's greatest diameter plus twice the narrowest margin required for complete removal.
Question 5: A surgeon performs a debridement of a 30 sq cm wound on a patient's leg. The debridement extends down to and includes the muscle tissue. What are the correct CPT codes for this service?
- 11042, 11045
- 11044, 11047
- 11043
- 11043, 11046 (Correct answer)
Correct answer: 11043, 11046
CPT code 11043 describes the debridement of muscle and/or fascia for the first 20 sq cm or less. Since the wound is 30 sq cm, the add-on code +11046 is used for each additional 20 sq cm or part thereof. Therefore, 11043 is reported for the first 20 sq cm, and 11046 is reported for the remaining 10 sq cm.
Question 6: A complex repair is performed on a 3.5 cm wound on the cheek. According to CPT guidelines, which of the following would NOT be a required component to justify coding a complex repair?
- Extensive undermining
- Layered closure (Correct answer)
- Debridement of wound edges
- Involvement of the vermilion border
Correct answer: Layered closure
While an intermediate repair requires a layered closure, a complex repair is defined as requiring more than a layered closure. It includes the requirements for an intermediate repair plus at least one of the following: extensive undermining, debridement of wound edges, involvement of specific anatomical structures like the vermilion border, or placement of retention sutures. Therefore, a layered closure alone is characteristic of an intermediate repair, not a mandatory component that distinguishes a complex repair.
AAPC - American Academy of Professional Coders Integumentary System Procedures Questions and Answers
A patient undergoes a full-thickness excisional biopsy of a 1.2 cm lesion on the neck.
The operative report states that the surgeon performed a layered closure of the 1.5 cm resulting defect.
How should this be coded?