General Surgery Coding Alert

  Latest on CPT, ICD-9 Codes for Lipoma Excision from Codify's General Surgery Coder: Clinical Scenario 1:
Question: The surgeon excised a lipoma from a patient’s back measuring 5.0 cm x 4.0 cm x 2.0 cm. Should we select 21930 or 11406 for this procedure?
Answer: The key to determining the correct code is the excision's depth. Assuming that the depth in this case is... ...to read the full article and get the access to other similar scenarios related to coding for Lipoma Excision, subscribe to Codify's General Surgery Coder.

Take a FREE Trial and use the tool before you subscribe.   Incorrectly coding lipomas as lesions can lead to drastically reduced reimbursements.

If coders arent clear about the definition of lipoma, dont read the operative report thoroughly or dont get clear information about the procedure from their surgeons, they mistakenly may go to the CPT integumentary section and bill for a lesion instead, says Janine Valentine, CPC, senior coder with Facey Medical Foundation, a multispecialty group of 109 providers, including four general surgeons, in Mission Hills, CA.

Even general surgeons can mark down excision of lipoma-flank as a lesion, and unless the physician dictates an accurate note or the coder reads the operative report, its hard to differentiate between the two procedures, Valentine says.

Valentine gives the following example: A patient sees the general surgeon about a mass in his flank, and the surgeon diagnoses 239.2 (neoplasm of unspecified nature; bone, soft tissue, and skin). In an outpatient surgery setting, the physician removes the mass but mistakenly marks down the procedure as removal of lesion. Without reading the operative report, the coder may bill out the procedure as 11404 (excision, benign lesion, except skin tag [unless listed elsewhere], trunk, arms or legs), when, in fact, the actual procedure performed was 21930 (excision, tumor, soft tissue of back or flank) and the post-operative diagnosis was 214.1 (lipoma, other skin and subcutaneous tissue).

Mislabeling the lipoma removal as an excision of a lesion is a costly error. If the procedure described above was inadvertently billed as a 11404 (lesion excision, 3.1-4.0 cm in diameter), it is assigned only 3.83 relative value units (RVUs), according to Medicares 1999 National Physician Fee Schedule Relative Value Guide, while the correct procedure, 21930, is worth 8.3 RVUs.

Note: RVUs vary from state to state. The figures quoted above were taken from the Health Care Financing Administration Web site (http://www.hcfa/gov).

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