General Surgery Coding Alert

Question: How should I code for the excision of a 2-cm lipoma on the forehead that was lying under the frontalis muscle?

Michigan Subscriber

Answer: Normally, lipomas (a noncancerous tumor) located beneath the skin are billed using musculoskeletal codes in the 20000 section of CPT. For example, excision of a lipoma in the flank should be coded 21930 (excision, tumor, soft tissue of back or flank) rather than as a lesion excision because lipomas are typically located in the subcutaneous tissue beneath the skin.

According to Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C., however, this general principle does not apply to lipomas on the face or forehead presumably because in such instances the skin is so close to the bone.

The only musculoskeletal excision code for the face, other than those involving bone, is 21015 (radical resection of tumor [e.g., malignant neoplasm], soft tissue of face or scalp). Because a radical resection was not performed, 21015 does not apply. Therefore, the excision of a lipoma on the forehead should be billed using 11442 (excision of benign lesion, face).