Guidelines on cuts and incisions in tumor removal


 

Taking care of the minute details when operating on a patient is a thumb rule for the surgeons, it becomes all the more essential during orthopedic surgeries, to make sure everything is done in the right manner. Read on to find about the techniques used in tumor removal during an orthopedic surgery.

People who have been coding orthopedic surgery for some time know there was always a question about excising of tumors , separation about when do we code from integumentary, and when do we code for musculoskeletal. But when we opted for musculoskeletal, there wasn’t always a code available for what we were excising. So in CPT 2010, there has been a cleanup, along with the availability of four options. For tumors that are below or in the skin, one needs integumentary. So, once we go to the subcutaneous area, then there are codes related to that in the musculoskeletal system. You can learn more about the coding system with new medical coding articles.

First is the subcutaneous soft tissue tumor, they're normally in always the subcutaneous tissue and above the deep fascia. These tumors are benign. And you just have to excise the tumor and take a very little margin to remove these tumors as they are benign.

Coding is done by the size and location of the tumor. So, it is done by the area of the body based on the musculoskeletal breakdowns. And then there's a set of codes within each section. A chunk of the greatest diameter of the tumor plus the margin at the time of the excision is to be kept in mind. And it's very important that surgeons provide the size plus the margin at the time of excision.

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A lot of times, either in the preparation of the tumor for pathology, or once it's been excised and been in air for a certain period of time, the tumors shrink, which is when you're not being able to utilize the reimbursement to the highest level. So, the patients need to talk to surgeons about that and tell them that they need the size at the time of excision. With all of these, the dice section or elevation of tissue planes is also included. The incisions and layering to get down to that soft tissue tumor is included in the codes.

The next deepest group of codes is the fascial or subfascial soft tissue tumors. They're confined to the fascia or into the deep fascia, and not to the bone. These can also be intramuscular as they can be growing into the muscle also. These are usually benign and are coded by size and location of the tumor. The greatest diameter of the tumor plus the margin is taken at the time of excision.

The next group of codes are the radical resection of a soft tissue tumor. The reason why it is called radical resection is because a large area of margin is to be taken out to remove these soft tissue tumors.

They could be subcutaneous or subfascial, but because of the extent of the tumor and the fact that they're usually very aggressive benign tumors or they're malignant tumors, the way that they spread, a large wide margin is ensured in order to make sure that the whole tumor is taken out. This also may include the removal of tissue of many layers. Coding is done this by size and location of the tumor and again, by measuring at the time of excision.

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