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Sebaceous Cyst Removal
We had a patient with a 3.5 cm sebaceous cyst removed from her abdomen. The physician had to cut into the subcutaneous tissue to remove it. Should we use a code from the Integumentary…
Question:
We had a patient with a 3.5 cm sebaceous cyst removed from her abdomen. The physician had to cut into the subcutaneous tissue to remove it. Should we use a code from the Integumentary section or the Musculoskeletal section to report this removal?
Answer:
You would report the appropriate code from the benign lesion excision section (in your case, 11404) for the removal. Sebaceous cysts are dermal in origin, even if they extend into the subcutaneous tissue, so they are not considered soft tissue tumors.
*This response is based on the best information available as of 08/23/18.
I&D of Abscess?
If one of our physicians uses a needle to puncture an abscess, but allows it to drain on its own and does not incise or aspirate anything into the syringe, can we bill 10060 for an incision…
Question:
If one of our physicians uses a needle to puncture an abscess, but allows it to drain on its own and does not incise or aspirate anything into the syringe, can we bill 10060 for an incision and drainage of an abscess? If not, could we use 10160 for puncture aspiration instead?
Answer:
No to both Question:s. CPT code 10060 includes incision and drainage, and you stated no incision was made. CPT code 10160 includes puncture and aspiration, and you stated no aspiration was made. The puncture as indicated in your scenario above would be part of the E/M service performed for the patient at that encounter.
*This response is based on the best information available as of 07/26/18.
Multiple Lesion Excisions. Do you add them together?
If I am excising multiple basal cell carcinomas on a patient’s chest, do I add the sizes and margins together and report one code since they are in the same anatomic group of CPT codes?
Question:
If I am excising multiple basal cell carcinomas on a patient’s chest, do I add the sizes and margins together and report one code since they are in the same anatomic group of CPT codes?
Answer:
No. For lesion excisions, each lesion plus it’s most narrow margin are reported separately. CPT guidelines state to “report separately each malignant lesion excised.” Remember, simple closure is bundled into lesion excision, but you would separately report intermediate or complex repairs. And, depending on the type of repairs performed, you may need to add the repairs together.
*This response is based on the best information available as of 03/01/18.
Repairs with Mohs Surgery
I know that simple repairs are included with lesion excisions, but what about Mohs surgery?
Question:
I know that simple repairs are included with lesion excisions, but what about Mohs surgery?
Answer:
Although simple repairs are included (bundled) into almost all integumentary codes, no repair is bundled into Mohs per the NCCI and CPT. The CPT guidelines for Mohs state that if a repair is performed, you can use separate repair, flap or graft codes to report. You can report simple repairs (12001-12018) along with Mohs codes (17311-17315).
*This response is based on the best information available as of 02/15/18.
Simple Laceration Repair on Skin Right Upper Eyelid
My physician did a simple laceration repair on the skin right upper eyelid. What procedure code should I report? My physician wants to use 67930.
Question:
My physician did a simple laceration repair on the skin right upper eyelid. What procedure code should I report? My physician wants to use 67930.
Answer:
For a simple repair of the skin of the eyelid, you should report 12011-12018 based on cm size of the repair. Report 12011 for a total length of 2.5 cm or less; 12013 for 2.6 cm to 5 cm; 12014 for 5.1 cm to 7.5 cm; 12015 for 7.6 cm to 12.5 cm; 12016 for 12.6 cm to 20 cm; 12017 for 20.1 cm to 30 cm; and 12018 if the total length is greater than 30 cm. When reporting repair of wounds, the lengths of all repairs are added together and the total is listed for each anatomical site. If the repair involves the lid margin you should report the repair with CPT 67930 (Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness) or 67935 (full thickness).
*This response is based on the best information available as of 11/02/17.
Paramedian Forehead Flap on Previous Mohs Surgery
My doctor did a division and inset of a paramedian forehead flap on a patient that had Mohs surgery on their nose. Do I code 15620 since the flap was brought from the forehead, or 15630…
Question:
My doctor did a division and inset of a paramedian forehead flap on a patient that had Mohs surgery on their nose. Do I code 15620 since the flap was brought from the forehead, or 15630 since the flap was placed on the nose?
Answer:
Good Question:. If you look at the code descriptors, they state, “Delay of flap or sectioning of flapat…” This means that the code is chosen for where the flap is inset. In your case, the flap was inset at the nose. CPT code 15630 for division and inset at the eyelids,nose, ears, or lips, would be the correct code to report. Don’t forget also that if repair of the donor site requires skin graft or local flap to repair, it is separately reportable. Hope this helps.
*This response is based on the best information available as of 07/27/17.