CPC - Certified Professional Coder CPT Surgery: Integumentary System Questions and Answers 1 — Questions and Answers
Question 1: A patient undergoes an excisional debridement of a 30 sq cm pressure ulcer on the right hip, with the debridement carried down to the bone. During the same operative session, a 15 sq cm pressure ulcer on the left buttock is debrided down to subcutaneous tissue. How should these services be coded?
- 11044, 11042-59 (Correct answer)
- 11047, 11045
- 11044, 11045
- 11042, 11044-51
Correct answer: 11044, 11042-59
CPT code 11044 is used for debridement of bone for the first 20 sq cm or less. The 30 sq cm hip ulcer debridement to bone is coded with 11044 for the first 20 sq cm and 11047 for the additional 10 sq cm. However, the question asks for the primary codes. CPT code 11042 is for debridement of subcutaneous tissue for the first 20 sq cm or less. Since the two debridements are on separate, distinct anatomical sites and are of different depths, they are coded separately. Modifier 59 is appended to the second procedure (11042) to indicate it is a distinct procedural service from the debridement to bone (11044). According to CPT guidelines, when coding for multiple wounds, you sum the surface area of wounds at the same depth, but do not combine sums from different depths.
Question 2: A surgeon excises a 2.5 cm malignant lesion from the patient's neck. To close the resulting 3.0 cm defect, an adjacent tissue transfer of 9 sq cm is performed. Which of the following is the correct CPT code assignment?
- 11623, 14040
- 14040 (Correct answer)
- 11623, 13131
- 14020
Correct answer: 14040
CPT guidelines state that the excision of a benign or malignant lesion is included in the code for an adjacent tissue transfer. Therefore, you should not code the lesion excision (11623) separately. The correct code is selected based on the location (neck) and the size of the defect to be repaired. Code 14040 describes an adjacent tissue transfer for a defect of 10 sq cm or less on the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet.
Question 3: A patient has a 3.0 cm laceration on her forearm and a 4.0 cm laceration on her trunk. Both wounds require layered closure of the subcutaneous tissue and superficial fascia. How would you report the wound repairs?
- 12032, 12031-51
- 12002, 12001
- 12034 (Correct answer)
- 13101, 13121
Correct answer: 12034
For intermediate repairs, CPT groups the scalp, axillae, trunk, and extremities (excluding hands and feet) into the same anatomical category. When multiple wounds of the same complexity and in the same anatomical group are repaired, their lengths are summed. In this case, the 3.0 cm forearm laceration and the 4.0 cm trunk laceration are both intermediate repairs in the same group, so their lengths are added together (3.0 cm + 4.0 cm = 7.0 cm). CPT code 12034 is for an intermediate repair of wounds in this anatomical group measuring 2.6 cm to 7.5 cm.
Question 4: A physician excises a benign lesion from a patient's scalp. The excised diameter, including margins, is 2.3 cm. The wound is closed with a simple, single-layer suture. Which CPT code(s) should be reported?
- 11422, 12001
- 11423 (Correct answer)
- 11623
- 11423, 12001
Correct answer: 11423
CPT codes for lesion excision (11400-11646) are selected based on whether the lesion is benign or malignant, the anatomical location, and the excised diameter (lesion diameter plus margins). In this case, the lesion is benign, located on the scalp, and has an excised diameter of 2.3 cm. CPT code 11423 is for the excision of a benign lesion from the scalp, neck, hands, feet, or genitalia with an excised diameter of 2.1 to 3.0 cm. Simple (single-layer) closure is included in the lesion excision codes and is not reported separately.
Question 5: A patient presents for the destruction of 18 actinic keratoses on their face and scalp using cryosurgery. What is the appropriate CPT code for this procedure?
- 17000, 17003 x17
- 17004 (Correct answer)
- 17111
- 17272 x18
Correct answer: 17004
CPT code 17004 is a standalone code used for the destruction of 15 or more premalignant lesions (e.g., actinic keratoses). It is not appropriate to bill CPT code 17000 (for the first lesion) and 17003 (add-on for each additional lesion) when 15 or more lesions are destroyed. Code 17111 is for destruction of 15 or more benign lesions other than skin tags or cutaneous vascular proliferative lesions, and 17272 is for destruction of a malignant lesion.
Question 6: A complex repair of a 3.5 cm defect on the forehead required extensive undermining and debridement of contaminated wound edges. Which CPT code correctly represents this procedure?
- 12052
- 13131
- 13132 (Correct answer)
- 12013
Correct answer: 13132
A complex repair involves more than layered closure and may include debridement, extensive undermining, or other specific criteria. The CPT codes for complex repair are selected based on the anatomic location and the length of the repair. Code 13132 is for the complex repair of a wound on the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet measuring 2.6 cm to 7.5 cm. Code 13131 is for a repair of 1.1 cm to 2.5 cm. Codes 12052 and 12013 represent intermediate and simple repairs, respectively, which are not appropriate for the documented complexity.
CPC - Certified Professional Coder CPT Surgery: Integumentary System Questions and Answers 1
A patient undergoes an excisional debridement of a 30 sq cm pressure ulcer on the right hip, with the debridement carried down to the bone.
During the same operative session, a 15 sq cm pressure ulcer on the left buttock is debrided down to subcutaneous tissue.
How should these services be coded?