CPC - Certified Professional Coder Integumentary System Procedures Questions and Answers — Questions and Answers
Question 1: A patient undergoes surgical debridement of a 35 sq cm wound on the lower back. The debridement is carried down to, but not including, the fascia. The documentation states that necrotic subcutaneous tissue was removed. How should this service be coded?
- CPT® 11042 for the first 20 sq cm and 11045 for the additional 15 sq cm. (Correct answer)
- CPT® 11043 for the first 20 sq cm and 11046 for the additional 15 sq cm.
- CPT® 97597 for the first 20 sq cm and 97598 for the additional 15 sq cm.
- CPT® 11042 for the entire 35 sq cm area.
Correct answer: CPT® 11042 for the first 20 sq cm and 11045 for the additional 15 sq cm.
CPT® code 11042 is used for the debridement of subcutaneous tissue for the first 20 sq cm or less. Since the debridement was of 35 sq cm, the add-on code +11045 is used to report each additional 20 sq cm, or part thereof. Code 11043 would be incorrect as it represents debridement down to muscle/fascia. Codes 97597 and 97598 represent selective debridement, which is different from the surgical excision described.
Question 2: A dermatologist performs three separate punch biopsies on a patient during the same office visit: one on the arm, one on the back, and one on the chest. How would these procedures be reported?
- 11104, 11105, 11105 (Correct answer)
- 11104 x 3
- 11104, 11104-59, 11104-59
- 11106, 11107 x 2
Correct answer: 11104, 11105, 11105
CPT® code 11104 is reported for the first punch biopsy of a single lesion. Add-on code +11105 is used for each additional punch biopsy performed on separate/additional lesions during the same encounter. Therefore, the first biopsy is coded with 11104, and the two additional biopsies are coded with 11105 twice.
Question 3: A surgeon excises a malignant lesion from a patient's trunk. The lesion itself measures 1.5 cm in diameter. The surgeon takes 0.5 cm margins on all sides. What is the correct CPT® code for this procedure?
- 11602
- 11603 (Correct answer)
- 11402
- 11601
Correct answer: 11603
To select the correct excision code, you must calculate the excised diameter. This is the diameter of the lesion plus two times the narrowest margin. In this case, it is 1.5 cm (lesion) + 0.5 cm (margin) + 0.5 cm (margin) = 2.5 cm. CPT® code 11603 is for the excision of a malignant lesion on the trunk, arms, or legs with an excised diameter of 2.1 to 3.0 cm.
Question 4: A patient presents to the emergency department with two lacerations on their right leg. The physician performs a two-layer closure on a 4.0 cm laceration and a single-layer closure on a 2.0 cm laceration. Both required extensive cleaning. Which of the following is the correct coding?
- 12032 for the intermediate repair and 12001-59 for the simple repair. (Correct answer)
- 12034 for the combined length of both lacerations.
- 13121
- 12032
Correct answer: 12032 for the intermediate repair and 12001-59 for the simple repair.
A two-layer closure with extensive cleaning is considered an intermediate repair. The 4.0 cm laceration on the leg is coded with 12032. The single-layer 2.0 cm laceration is a simple repair, coded with 12001. Because the repairs are of different complexities, they are coded separately. The more complex procedure is listed first, and modifier 59 is appended to the lesser procedure to indicate it was a separate and distinct service.
Question 5: Which of the following is bundled into the Mohs micrographic surgery codes (17311-17315) and should NOT be reported separately by the Mohs surgeon?
- Complex repair of the surgical defect.
- Adjacent tissue transfer to close the defect.
- Pathologic examination of the tissue blocks. (Correct answer)
- A skin biopsy of a separate, unrelated lesion.
Correct answer: Pathologic examination of the tissue blocks.
The Mohs surgery codes (17311-17315) are unique in that they include the services of the physician acting as both surgeon and pathologist. The removal of stages, mapping, and the pathologic examination (histopathology) of the tissue blocks are all included in the Mohs codes. Repairs (intermediate, complex, flaps, grafts) are coded separately.
Question 6: A surgeon removes a 15 sq cm carcinoma from a patient's scalp, resulting in a 15 sq cm surgical defect. To close the defect, the surgeon creates an adjacent tissue transfer (local flap). How is the code for the adjacent tissue transfer selected?
- Based on the size of the flap created.
- Based on the size of the primary defect (15 sq cm).
- Based on the combined size of the primary defect and the secondary defect created to mobilize the flap. (Correct answer)
- Based on the length of the incision required to create the flap.
Correct answer: Based on the combined size of the primary defect and the secondary defect created to mobilize the flap.
According to CPT® guidelines for adjacent tissue transfer (codes 14000-14302), coding is based on the total area of the defect to be repaired. This includes the area of the primary defect (from the excision) plus any secondary defect created by the design of the flap. Therefore, the total square centimeters of both defects measured together determines the correct code.
CPC - Certified Professional Coder Integumentary System Procedures Questions and Answers
A patient undergoes surgical debridement of a 35 sq cm wound on the lower back.
The debridement is carried down to, but not including, the fascia.
The documentation states that necrotic subcutaneous tissue was removed.
How should this service be coded?