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.

Sebaceous Cyst Removal

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?

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.