Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Excision of Lesion or Tissue of Skin and Subcutaneous Tissue


Specialists

  • Dermatologist
  • General Surgeon
  • Plastic Surgeon

Comorbid Conditions

Factors Influencing Duration

The underlying condition and presence of complications may influence the length of disability. The presence of malignancy, the extent of surgery, and the need for other cancer treatments may also influence the length of disability. Duration depends on site, extent, and underlying condition.

Medical Codes

ICD-9-CM:
18.2 - Excision or Destruction of Lesion of External Ear
18.29 - Excision or Destruction of Other Lesion of External Ear; Cauterization of External Ear; Coagulation of External Ear; Cryosurgery of External Ear; Curettage of External Ear; Electrocoagulation of External Ear; Enucleation of External Ear
21.3 - Local Excision or Destruction of Lesion of Nose
21.30 - Excision or Destruction of Lesion of Nose, Not Otherwise Specified
21.31 - Local Excision or Destruction of Intranasal Lesion; Nasal Polypectomy
21.32 - Local Excision or Destruction of Other Lesion of Nose
61.3 - Excision or Destruction of Lesion or Tissue of Scrotum; Fulguration of Lesion of Scrotum; Reduction of Elephantiasis of Scrotum; Partial Scrotectomy of Scrotum
86 - Operations on Skin and Subcutaneous Tissue
86.09 - Other Incision of Skin and Subcutaneous Tissue; Creation of Thalamic Stimulator Pulse Generator Pocket, New Site; Escharotomy; Exploration: Sinus Tract, Skin, Superficial Fossa; Relocation of Subcutaneous Device Pocket NEC; Reopening Subcutaneous Pocket for Devise Revision without Replacement; Undercutting of Hair Follicle
86.2 - Excision of Lesion or Tissue of Skin and Subcutaneous Tissue
86.22 - Excisional Debridement of Wound, Infection, or Burn; Removal by Excision of: Devitalized Tissue; Necrosis, Slough
86.25 - Dermabrasion, That with Laser
86.3 - Other Local Excision of Lesion or Tissue of Skin and Subcutaneous Tissue; Destruction of Skin By: Cauterization, Cryosurgery, Fulguration, Laser Beam; That with Z-plasty
86.4 - Radical Excision of Skin Lesion; Wide Excision of Skin Lesion Involving Underlying or Adjacent Structure

Overview

The skin is the tough layer of tissue that covers the body. It is the largest organ of the body and is divided into an outer layer of cells (epidermis) and a deeper layer containing blood and lymphatic vessels, nerves, and hair follicles (dermis). Subcutaneous tissue lies beneath the skin and contains fat tissue, blood vessels, and nerves. A skin lesion is any visible abnormality of the skin, including wounds; sores; rashes; boils; cysts; moles; vascular birthmarks; vascular, nerve, or fat tumors; excessive scar tissue (keloids, hypertrophic scars); and malignant tumors. Such lesions may be noncancerous (benign), cancerous, large (gross), not directly visible (occult), or the originating point of growth (primary). Sometimes, there can be microscopic invasion of apparently healthy tissue by a lesion such as skin cancer. Excision of a lesion refers to the removal of a lesion and part of the surrounding, normal-appearing tissue.

Source: Medical Disability Advisor



Reason for Procedure

Excisions of a skin lesion or subcutaneous tissue are performed therapeutically, diagnostically (excisional biopsy), and/or cosmetically. Therapeutic excision of skin lesions is done to remove skin cancers or lesions suspected of being skin cancers. Therapeutic excisions may also be performed when the lesion is exposed to repeated rubbing or bumping, which may lead to bleeding and ulceration. Boils, cysts, moles, birthmarks, tumors, scars, and malignant tumors are all conditions that are treated with therapeutic excision.

Diagnostic excision is performed to determine the cause of a lesion. Excision of malignant lesions is necessary for treatment and to prevent spreading to deeper or distant tissues (metastasis). Wide excision of malignancies ensures a better chance of eradication of the lesion. Excision of a benign lesion or tissue may be necessary if it is enlarging or spreading, if it is bothersome or painful, or if the appearance is unsightly. Cosmetic excision is done to remove moles, scars, cysts, and vascular birthmarks at the request of the individual in order to enhance appearance.

Source: Medical Disability Advisor



How Procedure is Performed

The area of the lesion is thoroughly cleansed with an antibacterial solution. Local anesthetic is given. In some cases, general anesthesia may be used. Depending on the type of lesion and its size, different excision techniques may be used. The techniques for removal of benign and malignant lesions vary. An abscess may merely be opened and drained (incision and drainage). For an abscess or an infected cyst, a stab incision is made down to the pus-filled cavity. The small stab incision is then enlarged to allow full drainage of the abscess. The tip of the forceps is introduced into the cavity, and then the jaws of the instrument are opened to improve drainage; additionally, the cavity should be explored to break down all small spaces. Samples of the pus can be obtained for identification of the bacteria responsible for the infection (culture). The contents can also be aspirated (suction) by a tube passed through the incision. After draining is complete, the cavity is thoroughly irrigated. The cavity may be packed with gauze containing an antibacterial medication. The exterior wound should be kept open until the cavity heals from within. A dressing is placed over the area. Treatment with antibiotics is unnecessary unless there is evidence of spreading infection, or unless the procedure was performed on the hand or face.

A cyst may be excised through incisions. For excision of a cyst, two slightly curved, intersecting, parallel incisions (elliptical) are made over the main portion of the cyst. Care is taken not to rupture the cyst. The incisions will be somewhat longer than the cyst, and the skin between the incisions will be removed intact with the cyst. The cyst and its covering skin can then be carefully lifted while gently cutting them away from the underlying tissue (dissecting). Any bleeding that occurs with removal is controlled with pressure, cauterization, or suturing. The skin is sutured together, and a dressing is applied.

Warts and nevi (birthmarks) may be removed by application of liquid nitrogen (cryotherapy), by application of topical medications that remove the lesion, and by surgical methods (electrosurgery, CO2 laser). Cryosurgery is performed by applying liquid nitrogen to the lesion, which causes freezing, until the area turns white. The area is allowed to thaw, and then the liquid nitrogen is reapplied. The wart will crust and fall off, usually in about a week. The procedure may be repeated if needed. Electrosurgery is performed by cleansing the area to be treated with a surgical scrub solution, injecting local anesthetic, and using electrosurgical equipment to apply heat to the lesion. Dressings are applied following the procedures. Many nevi require no treatment at all. Nevi with a potential for becoming malignant may be biopsied and/or removed. Lesions that may be malignant are removed. Skin lesions that are to be biopsied may be removed by cutting the lesion above the skin line (shave biopsy), removing an oval core from the center of the lesion (punch biopsy), or removing the entire lesion and its borders (excisional biopsy).

Source: Medical Disability Advisor



Prognosis

The predicted outcome varies, depending on the type and size of the lesion and on whether the lesion is benign or malignant. Benign lesions should heal without problems. Malignant lesions found and treated in very early stages may also heal without problems. Depending on the findings of biopsy and other indications, further treatment with chemotherapy or further surgery may be necessary. More advanced or spreading malignant lesions may require extensive surgery for removal, including grafting or reconstructive surgery.

Source: Medical Disability Advisor



Complications

Complications may include infection, bleeding, scarring, numbness, clotted blood that persists under the skin, and spread of malignancy. Cryosurgery may cause permanent loss of skin color (depigmentation) in blacks and other individuals who have darkly pigmented skin. Numbness may persist for 6 months or as long as 2 years. Persistent blood clots may go unresolved for 6 months or longer.

Excessive scar tissue (keloids) may form at the site of a skin excision, especially in blacks. Most are of cosmetic concern, but the disfigurement may be substantial. When the keloid grows over a joint, significant loss of motion may follow. Unfortunately, keloids tend to regrow after excision.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions include hygienic care of the surrounding skin to prevent infection and avoidance of trauma until the wound is healed. Recovery from a skin excision may require time off from work, or restricted activity may be necessary. If heavy lifting on the job is required, the individual may need to be reassigned in order to allow healing and prevent separation of the tissue at the incision. Heavy lifting places excessive stress and tension at incision sites on fingers and hands, the abdomen, knees, or any other area bearing weight or involved in movement.

Source: Medical Disability Advisor



References

General

Buffington, Sherry, and Clare Brabson. "Specimen Collection and Testing." Nursing Procedures. Ed. Nancy H. Homes. 3rd ed. Springhouse, PA: Springhouse Corporation, 2000. 132-165.

Ely, John W. "Excision of a Sebaceous (Epidermal) Cyst." Saunders Manual of Medical Practice. Ed. Robert E. Rakel. 2nd ed. Philadelphia: W.B. Saunders, 2000. 1267-1269.

Ise, Charleen. "Percutaneous Incision and Drainage of Abscess." Saunders Manual of Medical Practice. Ed. Robert E. Rakel. 2nd ed. Philadelphia: W.B. Saunders, 2000. 1270-1272.

Source: Medical Disability Advisor






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