What Constitutes the Trunk for Complex Repairs?

Question:

CPT question for anatomy: When coding complex repairs CPT 13100-13102 for complex repair of trunk. What body area is included in the “Trunk”.  For simple and intermediate repairs the trunk is included with the scalp, extremities, neck, axillae and trunk.

Answer:

You can determine the answer by looking at the code descriptors for the other complex repair anatomic groupings. CPT codes 1312-13122 include the scalp, arms, and/or legs; CPT codes 13131-13133 include the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet. Therefore, 13100-13102 is specifically just the trunk – chest, abdomen, and back.

*This response is based on the best information available as of 10/17/19.

Lesion Excision and Repair

Question:

I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the repair or is it included? My coder says it is billable with Modifier 59. Can you provide some guidance?

Answer:

You are correct that you report CPT code 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm) for the excision. Yes you can report the repair based on CM size which would be coded with CPT code 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm). You would not append Modifier 59 since it is not a bundled service. The correct modifier to use is 51 and append it to the lesser RVU procedure which is the repair.

*This response is based on the best information available as of 07/25/19.

Ear Biopsy

Question:

What is the correct code for a tangential biopsy of the antihelical fold?  I was going to bill 11102, but I was told that there are different codes in other sections of CPT for some biopsies.

Answer:

The correct code would be 69100,Biopsy external ear.  As a bonus, this correct code would reimburse at a higher level than 11102.  According to the Medicare fee schedule, the national reimbursement rate for 11102 is $41.08 and for 69100 it is $50.45.

*This response is based on the best information available as of 5/23/19.

Pilonidal Cyst Removal and Repair

Question:

If one of our doctors removes a complex pilonidal cyst that requires a rhomboid flap repair, is the repair part of the code 11772 for complicated excision of the pilonidal cyst?  I did not think so, but I know that each procedure includes the approach, the definitive, and closure, so now I am not sure.

Answer:

A flap closure is separately reportable with an excision of a pilonidal cyst.  In this case, you would also report a code from the adjacent tissue transfer section, 14000-14302, depending on the site and square centimeter sizes of the primary and secondary defects.

*This response is based on the best information available as of 2/14/19.

Skin Tag Removal

Question:

One of the doctors removed 4 skin tags by shave, so she wants to code them as shaves of epidermal lesion codes 11300-11313.  Is that correct?

Answer:

No. The skin tag removal codes 11200-11201 should be reported as they are diagnosis-code specific.  The method of removal is not the driver for the code choice.  CPT guidance on the codes state that removal of skin tags “include scissoring orany sharp method, ….” which would include shave.

*This response is based on the best information available as of 1/31/19.

Division and Inset of Flap

Question:

A patient presents for division and inset of a neck-to-ear pedicle flap.  Should we report 15620 or 15630?

Answer:

The CPT codes reported for the division and inset are chosen by the permanent inset site, not the donor site.  So in your case, CPT code 15630 (Delay of flap or sectioning of flap at eyelids, nose,ears, or lips) would be reported, not 15620 (Delay of flap or sectioning of flap at forehead, cheeks, chin,neck, axillae, genitalia, hands, or feet).

*This response is based on the best information available as of 11/01/18.