Ok Here is a cpc exam question from Laura, a Blitz student, its about integumentary surgery
coding, and she says can you help me with this question?
"When you are coding lesions and they give you the diameter, do you code based on the
first square cm or do you multiple that?
This must be from a cpc practice exam and the question reads: A patient has a 4 x 3
cm x 2 cm lesion on the left thigh, (hint: a poll is coming up) that was excised.
Due to the size and location of the lesion the decision was made to harvest a full thickness
graft from his lower lef leg.
An incision of 5 cm x 5 cm full thickness graft was obtained
and grafted onto the defect and sewn.
The pathology finding confirmed that the lesion was basal cell carcinoma.
The CPT codes are, and we are given these four choices
and she said my answer was, I change it to X because I wanted to see what you guys think
it is based on a guess
and it was correct but I really need to get a fundamental understanding of the lesion
diameter coding.
Thank you very much.Ok.
So let's do the poll and launch that.
Give you guys a minute or two to fill that out.
What do you think the answer is to that question?
Votes are coming in, 16 % have voted, I'm not going to tell you which one seems to be
the winner.
Alright, so we are going to close the poll.
Interesting, interesting, interesting.
So 5% voted for a, 10% for b, 50% for c and 35% for d.
Let's see how you did and the student asking the question she picked "C" as well as the
majority of you.
I ought to make this... what's that game, who wants to be a millionaire?
(Alicia - who wants to be a coder?)
Alright, here's another one very color coded,
I just repeated the question here,
so right off the back I'm looking for the same code in different answers I see 11606
in answer c and d.
The other codes are one of a kind for the questions so my spidy sense says its going
to be answer c. or d without even reading the question,
which probably a lot of you guys were picking up from the previous tip here.
Just to confirm, I'm going to look at 11606 and I've copied and pasted it here, excision
of malignant lesion including margins, trunk, arms or legs, excised diameter over 4.0 cm.
So we can see that malignant matches because it is basal cell carcinoma and that it was
of the legs,
left thigh that was excised and that it was of the legs,
and that now the question was specific to how to handle the square centimeters in that.
So what I did was - with grafting, you normally have to identified the recipient site and
the donor site if its an autograft coming from the patient versus an allograft which
is coming from like a cadaver or a live donor . but normally live people don't donate their
skin.
So in this case its an autograft because it said patient had the lesion on the left thigh
and they harvested a graft from the left lower leg.
So the left lower leg was helping out the left thigh.
So the left thigh said 4.3 x 2.
You multiple it.
So that becomes an 8.6 square cm defect area.
You multiply it!
The donor site, the graft lower leg was 5 x 5 so its 25 sq cm.
So, in this case its talking about excision of malignant...then we have to do the math
for the 15220 and .... over and 15221.
220 is 20 squ cm or less and then the add on code additional 20 square cm, and this
is a key phrase guys: "or part thereof So we had 25 sq cm so we need 15220 for 20 of
it and then the add on code for the 5 because 5 is a part thereof of 20.
OK?
So hopefully that makes sense.
So if you voted for "c" you were correct.
Also if you happen to look up 15150 first instead of the 15220, you could have thrown
that out because that one said a tissue culture skin autograft and no where in the blip that
we read did it talk about a cultured skin autograft.
You would have seen something like it said they took it out red, did it talk about a
cultured skin autograft.
You would have seen something like, they took it out, they prepared it or did something
like that.
It didn't say that at all, just a straight up graft.
So hopefully that will help you a little bit with that integumentary cpc practice exam
question.