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Question: Hello, I need help finding the procedure code for a pilonidal cyst debridement. The notes are as follows:

Preoperative Diagnosis: Pilonidal disease
Postoperative Diagnosis: Pilonidal disease of natal cleft

Careful examination of the area of pilonidal disease revealed multiple small sinus tracts in the midline but no evidence of active infection. We used lacrimal duct probes to carefully probe sinus tracts and assure that disease was not incredibly extensive or that there was active infection in the area. We determined that there was no active infection, and it was safe to proceed. We anesthetized the area with local anesthetic.

We carefully dilated the sinus tract to allow placement of a small cervical cytology brush. We used the brush and lacrimal duct probe to help debride granulation tissue from the sinus tract in the area of the pilonidal cyst. We also irrigated the area copiously with normal saline solution using an angiocatheter to flush debris and granulation tissue from the area.

After this, we used Tisseel fibrin glue injected into the sinus tract to seal the pilonidal cyst and tract. Once this was done, we applied direct pressure to the area. We assured that there was no bleeding and that the Tisseel was filling the entire pilonidal cyst and sinus tract.

We then injected additional local anesthetic in the area. The area was then dressed with sterile 4 x 4’s and tape.

We reported L08.89 (Other specified local infections of the skin and subcutaneous tissue) for the post-op diagnosis, but what procedure codes would you suggest we report?

AAPC Forum Participant

Answer: Due to there being no description of excision or incision in the detail you described in this procedure, neither pilonidal cyst excision CPT^® codes 11770-11772 (Excision of pilonidal cyst or sinus…) nor incision and drainage codes 10080-10081 (Incision and drainage of pilonidal cyst…) would be appropriate here. There is currently no CPT^® code that describes treating a pilonidal cyst with fibrin glue; therefore, it would be appropriate to use code 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue).

You might also reconsider your original ICD-10-CM choice as you stated there was no active infection. Code L05.91 (Pilonidal cyst without abscess) would be more appropriate in this scenario, but you may want to query your provider.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC