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
  • Hand 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:
18.29 - 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
21.31 - Local Excision or Destruction of Intranasal Lesion; Nasal Polypectomy
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
86.09 - 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
86.22 - 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 unique. Skin helps regulate body temperature; permits the sensations of touch, heat, and cold; and protects from microbes and environmental elements. It is the largest organ of the body, covering about 20 square feet with a weight of 4 kg (6% of total body weight), a volume of 4000 cm3, and a thickness of 2.2 mm in an average adult. Skin has three layers: the outer layer of cells (epidermis); the dermis (just beneath the epidermis) which contains connective tissue, hair follicles, and sweat glands; and a deeper subcutaneous tissue layer (hypodermis) made of fat (adipose) and connective tissue. This layer also contains blood and lymphatic vessels. A skin lesion is any visible abnormality of the skin, including wounds, sores, rashes, boils, cysts, moles (nevus), birthmarks (which can be vascular or pigmented), vascular malformations, fat tumors (lipomas), excessive scar tissue (hypertrophic scars, keloids), and malignant skin tumors (melanomas). 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. The excision can be of the abnormal tissue only or can include part of the surrounding normal 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 can be treated with therapeutic excision.

Diagnostic excision is performed to determine the cause of a lesion. After the diagnosis is confirmed, a therapeutic excision procedure may be performed to try to remove all of the abnormal tissue.

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. Excision of malignant lesions is necessary for treatment and to decrease the likelihood of spreading to deeper or distant tissues (metastasis). Wide excision of malignancies decreases the chances of recurrence of the lesion.

Source: Medical Disability Advisor



How Procedure is Performed

The area of the lesion is thoroughly cleansed with an antibacterial solution. Depending on the size and location of the lesion, local anesthetic can be used. In some cases, a regional block or general anesthesia may be used. Depending on the type of lesion and its size, different excision techniques are appropriate. 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, an incision in the appropriate direction is made into the pus-filled cavity. The small incision is then enlarged to allow for drainage of the contents 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 open any other small spaces. Samples of the contents (pus) should be obtained for identification of the bacteria responsible for the infection and its susceptibility to antibiotics (culture and sensitivity test). Irrigation (washing out the abscess) and or suction of the contents can reduce the likelihood for recurrence. The cavity may be packed with gauze containing an antibacterial medication. The exterior wound may be kept open until the cavity heals from within or a secondary wound closure a few days later may be performed. A dressing is placed over the area to encourage additional drainage. Treatment with antibiotics is appropriate. Once the culture and sensitivity test results are obtained, the antibiotic can be changed to the antibiotic that is most effective.

A cyst (or ganglion), which is a fluid filled sac that is not infected, may be excised through a small incision. If the cyst is attached to the skin, a section of the skin may need to be removed along with the cyst. This is accomplished by two slightly curved, intersecting, parallel (elliptical) incisions made over the main portion of the cyst. Care is taken not to rupture the cyst; however, if the cyst is attached to a stalk originating from a tendon sheath, the stalk must be cut and removed. Ideally, 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 it 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. If the cyst is in the deeper subcutaneous tissue (hypodermis), a single straight-line incision can be made directly over the cyst and then the dissection can be done around the cyst (elliptically) and the cyst removed. This provides for a better scar after surgery.

Warts and 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 freezes the area until it 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.

Nevi (plural for nevus) is an umbrella term for a group of benign, circumscribed overgrowth of cells composed of tissue elements normally present in the skin. The mole (melanocytic nevus) is the most well-known of this group and is composed of an increased proliferation of melanocytes. Other examples include vascular nevi, epidermal nevi, and connective tissue nevi. Melanocytic nevi can be congenital, but most are acquired after birth and their appearance varies greatly. They are often described as flat, elevated, smooth, rough, polyp-like, or sessile. Most are a shade of brown, but some may be skin-colored or occasionally blue. Before using cryotherapy on nevi it is important to distinguish a melanocytic nevus from malignant melanoma. Melanocytic nevi are usually symmetrical in shape, have regular borders, a uniform color, and are small in size (diameter < 6 mm). If the diagnosis is uncertain, a biopsy (preferably excisional) should be performed first before doing cryotherapy.

Many nevi require no treatment at all but close observation for changes. However, nevi with a potential for becoming malignant may be biopsied and / or removed. Any lesions that are 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 if totally excised 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



Rehabilitation

Please refer to the frequency of visits below.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistExcision of Lesion or Tissue of Skin and Subcutaneous Tissue
Occupational or Physical TherapistUp to 2 to 4 visits if needed for ganglionectomy or incision and drainage of deep abscess

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 some individuals. This is more noticeable in individuals who have darkly pigmented skin. Numbness may persist for 6 months or as long as 2 years. Persistent blood clots are unusual.

Excessive scar tissue (keloids) may form at the site of a skin excision, especially in individuals with darkly pigmented skin. Most are of cosmetic concern, but the disfigurement may be substantial. When a 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 site. 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.

Risk: Work activities have little or no effect on the occurrence of most skin lesions. Exceptions may occur with specific jobs that place body areas on surfaces that cause rubbing or abrasions. Safety equipment, such as gloves on the hands, may reduce this risk.

Capacity: The ability to work (capacity) may be affected by the location of the lesion(s) and the size of the incision required for removal or biopsy. Capacity is based on traditional wound healing requirements.

Tolerance: Some biopsies or excisions may be painful. The amount of pain would be based on the location and size of the lesion and the individual's tolerance for pain. Each individual is unique regarding their ability to tolerate pain.

Accommodations: Accommodations may be appropriate based the location and size of the lesion, and the individual’s tolerance. Keeping the incision dry and clean for two weeks may impact job options.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



References

General

"Specimen Collection and Testing." Nursing Procedures. 5th ed. Springhouse, PA: Springhouse Corporation, 2009. 187-222.

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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