Integumentary System (10030-19499)

Medical coders must clearly understand terminology used in the CPT manual for integumentary procedures.

The Office of Inspector General OIG closely monitors dermatology services because of high audit risk, especially for lesion removals, biopsies, and destruction procedures.

Key CPT Descriptors You Must Understand

Quantity Terminology

• Each

• Each separate

• Each additional

• Single

• Multiple

• Any number

Audit risk: Incorrect counting of lesions can lead to overbilling or unbundling.

Severity Terminology

• Simple

• Complicated

• Extensive

Audit risk: Upcoding severity without documentation is a common OIG finding.

Size Terminology

• Small

• Medium

• Large

Audit risk: Lesion size must be documented before destruction or excision, not after.

Depth Terminology

• Superficial

• Deep

• Subcutaneous

Audit risk: Depth determines code selection. Coders must not assume depth.

Method Terminology

• Incision

• Excision

• Biopsy

Audit risk: Biopsy codes are frequently misused when the lesion is fully removed.

Common Integumentary Procedural Terms and Definitions

Allograft

• Skin graft from one person to another

• Donor is usually a cadaver

Anesthetics

• Applied to the skin to deaden pain

• Included in most minor procedures unless stated otherwise

Autograft

• Skin graft from the patient’s own body

Biopsy

• Removal of tissue by needle, knife, punch, or brush

• Used for diagnostic purposes

• Do not report biopsy if the entire lesion is removed

Cauterization

• Destruction of tissue using chemicals, electricity, heat, or freezing

Chemabrasion

• Abrasion using chemicals

• Also known as chemical peel

Cryosurgery

• Destruction of tissue using extreme cold

Audit note: Document number of lesions and method clearly.

Curettage

• Removal of superficial skin lesions using a curette

Debridement

• Removal of foreign material or dead tissue from a wound

OIG focus: Depth and type of tissue removed must be documented.

Dermabrasion

• Mechanical abrasion using wire brushes or sandpaper

• Used for scars, tattoos, and acne

Dermatoplasty

• Skin grafting or transplantation

Electrocautery

• Tissue destruction using electric current

Excision

• Removal of tissue by cutting

• Includes margins when documented

Audit risk: Incorrect margin calculation is a frequent error.

Frozen Section

• Rapid microscopic examination of frozen tissue

• Often bundled into surgical procedures

Heterograft

• Skin from another species usually pig

• Also known as xenograft

Incision and Drainage I and D

• Surgical opening to allow drainage of pus or fluid

Audit focus: Simple versus complicated must be clearly supported.

Laser Therapy

• Destruction of lesions using focused laser energy

Liposuction

• Removal of fat using suction

Rhytidectomy

• Surgical removal of excess skin

• Commonly called face lift

Skin Graft

• Transfer of skin to cover another site

• Common in burn treatment and post excision repair

OIG Coding Compliance Tips for Dermatology

• Never assume lesion size, depth, or malignancy

• Documentation must support each CPT descriptor

• Do not report biopsy when excision is performed on the same lesion

• Count lesions accurately

• Avoid automatic use of complicated or extensive codes

• Always verify bundling rules and NCCI edits

Dermatology is a high audit specialty.
Correct coding depends on precise documentation, not assumptions.

Skin, Subcutaneous, and Accessory Structures

Image Guided Fluid Collection Drainage

CPT 10030
Image guided fluid collection drainage by catheter
Percutaneous approach

Used for soft tissue collections such as
– Abscess
– Hematoma
– Seroma
– Lymphocele
– Cyst

• Applies to soft tissue locations only, including
– Extremity
– Abdominal wall
– Neck

• Imaging guidance is included and not reported separately

• Code is reported once per collection drained, regardless of catheter size or duration

Soft Tissue Marker Placement Codes

• CPT 10035
Placement of soft tissue localization devices such as clips or markers
First lesion

• CPT +10036
Placement of soft tissue localization devices such as clips or markers
Each additional lesion

• Code +10036 is an add on code
• Add on codes must never be reported alone
• Add on codes are modifier 51 exempt

Important Site Specific Coding Rule

• CPT codes 10035 and +10036 are for soft tissue only

• Do NOT use these codes for breast procedures

• For breast marker placement, use existing breast specific codes
– 19081 to 19086 for biopsy guidance
– 19281 to 19288 for breast localization

• If a more specific anatomic site than soft tissue is applicable
– Always use the site specific CPT codes instead of 10035 or +10036

Reporting Guidelines and Audit Tips

• Codes 10035 and +10036 are reported once per target lesion
• This is true regardless of the number of markers placed for that lesion

• Multiple markers placed to define one target
– Report only one unit of 10035

• Multiple separate lesions
– Report 10035 for the first lesion
– Report +10036 for each additional lesion

• Do not report additional units based on
– Number of markers
– Number of clips
– Number of passes

Key OIG and Compliance Takeaways

• Always verify anatomic site before selecting marker placement codes
• Avoid using soft tissue codes when site specific codes exist
• Over reporting units for multiple markers on one lesion is a common audit risk
• Documentation must clearly identify
– Target lesion
– Anatomic location
– Imaging guidance used

Paring or Cutting (11055-11057)

Paring or Cutting (11055-11057)

• Involves superficial removal of lesion using a curette.
• Refers to benign hyperkeratotic lesions like corn or callus.
• The number of keratotic lesions removed should be totaled and the appropriate code selected.
• To report destruction, see codes 17000-17004.
• Only one code from this series is reported for the total number of lesions pared or cut.

Example #1: Paring of 1 lesion.

Example #2: Paring of 2 lesions with established patient level 4 E/M service for another condition on the same day.

Example #3: Two lesions are pared from the right foot and three lesions are pared from the left foot.