Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes are reported? A. 17313, 17314, 17314 B. 17313, 17315 C. 17260, 17313, 17314 D. 17313,17314, 17315 - CORRECT ANSWER Patient is having Mohs Micrographic Surgery being performed only, eliminating multiple choice answer C. Mohs codes are based on the anatomic grouping by code, the number of stages taken, and number of blocks per stage. The surgery was on the back reporting code 17313 for stage 1 with three blocks, add-on code 17314 is for stage 2 with five blocks, and add-on code 17315 is for the sixth block in stage 2. Answer D 45 year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported? A. 14060 B. 11642, 14060 C. 11642, 15115 D. 15574 - CORRECT ANSWER An adjacent tissue transfer (advancement flap) was used to repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are not separately reported. This eliminates multiple choice answer B. Answer A 24 year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is: A. 56405 B. 10061 C. 11004 D. 11042 - CORRECT ANSWER The abscess had already burst, with no need to perform an incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia. Answer C 76 year-old female had a recent mammographic and ultrasound abnormality in the 6 o'clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT® and ICD-10-CM codes describe this procedure? A. 19100, N63 B. 19285, C50.912 C. 19120, R92.8 D. 19125, D24.2 - CORRECT ANSWER You can narrow your choices down by the diagnosis. The beginning of the operative note documents that core biopsies showed "papilloma". In the ICD-10-CM Alphabetic Index, look for Papilloma-see also Neoplasm, benign, by site. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/breast/Benign (column) refers you to code D24.-. Turn to the Tabular List to complete the code, D24.2. Procedure code 19125 is correct because preoperative placement of radiologic marker (preoperative needle localization with hookwire needle injection with methylene blue) was used to excise the lesion. Answer D The patient is a 66 year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used? A. 26123-RT, 26125-F7 B. 26121-RT C. 26035-RT D. 26040-RT - CORRECT ANSWER The patient is having a fasciectomy, eliminating multiple choice answers C and D. The fasciectomy was performed on the right hand supported by the documentation that states: "the fascial attachments to the flexor tendon sheath were released" and "subtotal palmar fasciectomy." Documentation also indicates the right middle finger ( modifier F7) had diseased fascia excised. Answer D