Anatomy lessons, guiding the bill

November 1, 2006

I do a lot of complicated skin cancer repairs and I have never really been very sure of the correct way to code for this particular type of closure: the purse string repair. I have spoken with several of my colleagues and everyone seems to be coding this differently. I have also scoured the CPT book with no real hints at what I should code. What do you think?

It's In the Bag

A. Dear Bag: I have never gotten a real answer from anyone either. I personally have never seen any articles on the coding of this particular type of repair so my best guess is that you code this to a complex repair (e.g., CPT codes 13100 to 13153) depending on site and size of the defect.

Do the ears, lips and eyes count as three different body areas or are they included in the main heading of face? I was also told that you can count the hands separately from the upper extremities? What exactly are the body areas for a full-body skin exam?

Head to Toe Derm

A. Dear Head to Toe: The skin portion of the single system integumentary exam includes the following body areas. I have put an "•" in front of each body area that represents one bullet or examined body area.

Neurological/Psychiatric (brief assessment of mental status including)

Constitutional

1. Sitting or standing blood pressure

2. Supine blood pressure

3. Pulse rate and regularity

4. Respiration

5. Temperature