The integumentary system in CPT coding typically covers procedures related to the skin, including surgeries, excisions, repairs, biopsies, and other interventions. Here are some key points to keep in mind while preparing for CPC exam.
Debridement
Debridement codes are divided based on depth of tissue and surface area of the wound.
Coding Tip – In the CPC exam we need to look for keywords like subcutaneous tissue, muscle, fascia and bone to select the identify the tissue where debridement is done.
Surface area of wound – What is the wound size.
Biopsy
These codes are assigned when biopsy is done solely for diagnostic histopathological examination and performed independently.
Surgical procedures to obtain tissue include excision, destruction and shave removals for pathological examination.
Three techniques for biopsy
Tangential Biopsy, Punch biopsy and Incisional biopsy
For these types of biopsy techniques simple closure is included.
Hierarchy to follow when more than one biopsy technique is involved.
Incisional > Punch > Tangential biopsy.
For example – When punch biopsy and tangential biopsy is given in question, we need to code punch biopsy first and then Tangential biopsy.
Removal of Skin tags
Shaving of epidermal or dermal lesions which includes removal of lesions by transverse incision or horizontal slicing.
Each lesion, one code should be assigned.
if more than lesion comes from same anatomical grouping, assign the same code for each lesion.
Excision Lesions
Excision is defined as full thickness (through the dermis) removal of lesions including margins, includes simple (non layered) closure and local anesthesia when performed.
Benign lesions
- For eg: Neoplasm, cicatricial, fibrous, inflammatory congenital, cystic lesions
- Full thickness (through the dermis) removal with margin
- Report separately each lesion.
- Excision with adjacent tissue transfer(ATT) report only ATT. Excision not separately reported
- Unusual or complicated lesion-add modifier 22
Malignant lesions
- Include simple closure, local anesthesia.
- Eg: Basal all carcinoma, squamous cell carcinoma, melanoma
- Full thickness removal of a lesion including margins
- Report separately each malignant lesion removed
- Excision & adjacent tissue transfer – Report only ATT Not report excision
- Re-excision if performed in post operative period of primary excision procedure Append 58 modifier
Measuring the diameter of lesion
Excised diameter = lesion + 2 x Margin diameter (cm)
Repair closure
| Simple | Intermediate | Complex |
| Superficial wound Epidermis, dermis, subcutaneous tissue Simple one layer closure | One or more deeper layer of SC tissue & superficial in addition to skin (epidermis & dermis) Single layer cloture of heavily contaminated wound with extensive cleaning or removal of particulate mater Include limited mining | In addition to Intermediate, exposure to bone, cartilage tendon Neuro-vascular structure debridement of wound eg: Traumatic lacerations or Avulsions Extensive undermining Doesn’t include: 1. Excision of benign malignant 2. Excisional preperation of wound 3. Debridement of open fracture open dislocation. |
Wound Repair
- Measured in cms.
- Multiple wounds add together lengths of wound from same classification (intermediate & Complex)
- Same group of anatomical site (trunk & extemites)
- More than one classification of wound repaired
- Code most complicated repair as primary procedure
- Code less complicated repair as secondary procedure with modifier 59
- Debridement – code as separate procedure when contamination requires prolonged cleaning
Adjacent Tissue Transfer (ATT)
Codes 14000 – 14302
- includes excision
- Repair by ATT
- Rearrangement (Z-Plasty,W-Plasty, VY-Plasty, Radiation Flap, Random Island Flap, Advancement Flap)
Excision of benign lesion or malignant lesion is not separately reportable with codes 14000-14302
Skin graft necessary to close secondary defect is coded as additional procedure
Two Type of defect
- Primary – From Excision
- Secondary – Flap design to perform the reconstruction
Both primary and secondary defects are measured together to determine the code.
If present in same anatomical group add the cms to determine the code.
Skin Replacement Surgery
Two steps
- Surgical preparation
- Topical placement of a auto graft or skin substitute graft
Sum of the surface area of all wounds from same anatomical sites are grouped together
Supply of skin substitute graft coded separately
Surgical preparation – no need to code if not mentioned.
If type of graft is not mentioned code from same skin substitute graft
Destruction
Ablation of benign, pre-malignant and malignant tissues.
By any method like electro-surgery, cryosurgery and laser and chemical treatment
With or without curettement, includes local anesthesia
Mohs micrographic surgery
Removal of complex or ill defined skin cancer with histopathological examination of the surgical margins
These codes are assigned only when an individual (physician) act as both surgeon and pathologist
The Mohs surgeon removes tumor tissue and maps, divides the tumor specimen into pieces and each piece is embedded into a individual tissue blocks for histopathological examination
Thus a tissue block in Mohs surgery is defined as an individual tissue piece embedded in a mounting medium for sectioning
If repair is performed, use separate repair, flap or graft codes
For the CPC exam, it’s essential to study the integumentary system thoroughly, including common procedures, coding guidelines, and associated modifiers.
Practice questions and mock exams can help reinforce your understanding and prepare you for the exam format.
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